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The purpose of this study was to investigate the relationship between TV viewing habits and attitudes towards mental health/disorders. Using a mixed design,
university students (n = 16/ group) completed questionnaires regarding their attitudes about mental health/disorders, and quantitative and psychological
aspects of their TV viewing habits approximately one week before, and immediately after watching one of three selected episodes of a popular TV medical drama series. Analyses indicated that aspects of mental health attitudes,
as measured by the Community Attitudes towards Mental Illness scale, were associated with perceived realism and psychological involvement in TV viewing. While it had been hypothesized that changes in mental health attitudes would be dependent upon the episode’s storyline (i.e., mental health-related or not) and the affective tone of the mental health storyline (i.e., positive or negative), no significant findings were obtained. Future analyses, based upon larger samples, controlling for participants’ level of psychological involvement may yield significant findings. Issues related to measurement of attitudes are also implicated.

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TV and Mental Health 1 Running Head: Television and Mental Health Watching TV – Exploring the relationships between TV viewing and attitudes towards mental health. Jodi Webster Submitted in partial fulfillment of Psychology 490 (Honours Thesis) requirements University of British Columbia – Okanagan TV and Mental Health 2 Abstract The purpose of this study was to investigate the relationship between TV viewing habits and attitudes towards mental health/disorders. Using a mixed design, university students (n = 16/ group) completed questionnaires regarding their attitudes about mental health/disorders, and quantitative and psychological aspects of their TV viewing habits approximately one week before, and immediately after watching one of three selected episodes of a popular TV medical drama series. Analyses indicated that aspects of mental health attitudes, as measured by the Community Attitudes towards Mental Illness scale, were associated with perceived realism and psychological involvement in TV viewing. While it had been hypothesized that changes in mental health attitudes would be dependent upon the episode’s storyline (i.e., mental health-related or not) and the affective tone of the mental health storyline (i.e., positive or negative), no significant findings were obtained. Future analyses, based upon larger samples, controlling for participants’ level of psychological involvement may yield significant findings. Issues related to measurement of attitudes are also implicated. TV and Mental Health 3 Watching TV – Exploring the relationships between TV viewing and attitudes towards mental health. Approximately 20% of the Canadian population will suffer from a mental health disorder at some point in their life (Canadian Mental Health Association [CMHA], 2008). Of those who suffer from depression or anxiety, only half of them will actually seek some kind of help or treatment for their mental health problem – despite the fact that these disorders are eminently treatable. Failure to seek help at all, or not until concerns have reached a critical point can be associated with tremendous costs, both personal and financial. There are also implications for an already overloaded health care system; for example, increased usage of medical services. Barriers to help seeking may include physical limitations (e.g., cost and accessibility), and ones that are internal to the individual (e.g., attitudes, beliefs and personality differences) (Mansfield & Addis, 2005). In this regard, it is well established that behaviors, including help-seeking behaviors, are informed by our attitudes and beliefs (MacKenzie, Knox, Gekoski & Macaulay, 2004). It has been demonstrated that negative attitudes towards mental illness – stigma - is not just restricted to attitudes towards the mentally ill from others who have no mental health concerns (i.e., public stigma; Corrigan, Green, Lundin, Kubiak & Penn, 2001). While non-sufferers may be less likely to interact with someone suffering from mental illness, stigma also influences how people suffering from a mental health disorder view their own illness (i.e., self-stigma). Research has suggested that stigma may help to explain why people with a mental health disorder often do not seek help (Vogel, Gentile & Kaplan, 2008). It is important to understand the variables that influence mental health stigma and our associated attitudes as these factors, in turn, may help to shape TV and Mental Health 4 possible prevention campaigns or at the very least make us aware of some of the factors that underlie our attitudes towards mental health. The present study examines the influence of TV on mental health-related attitudes. Research suggests that for many people, the media is a major source of information about mental health (Stuart, 2006; Diefenbach, 1997). TV is believed to be especially influential. Statistics indicate that on average, Canadians watch 21.4 hours of TV per week (Statistics Canada, 2006). Moreover, the most popular genre was drama, which accounted for 28.7% of Canadian TV viewing hours. In this regard, it has been demonstrated that fictional (e.g., drama series) and non-fictional (e.g., news, documentaries) are more likely to contain content that deals with mental health, as compared to other genres of TV (e.g., sports, educational, science-fiction) that are less likely to contain mental health-related topics (Signoreilli, 1989; Diefenbach, 1997). For example, Signoreilli (1989) evaluated the mental health portrayals on primetime TV and found that 20% of dramas contained issues specific to mental health. Almost a third of these appeared during the evening timeslots. Further, 3% of characters were depicted as having a mental health disorder. Similarly, Diefenbach (1997) analyzed 168 hours of prime-time television (184 programs) and found that 2.2% of the characters that had a speaking role within these programs were portrayed as having a mental illness. These rates are higher than expected. For example, while prevalence rates in Canada vary across specific disorders, the rates are often less than 1% (Health Canada, 2002). For example, bipolar disorder is estimated to affect 0.2% - 0.6% of the population, and schizophrenia is estimated at 0.3% in any given 1-year period. TV and Mental Health 5 Unfortunately, research has also demonstrated that the information concerning mental health/disorders that is presented in the media is frequently negative and inaccurate (e.g., portrayals of unpredictablity, dangerous behavior and aggressive acts) (Signoreilli, 1989; Diefenbach, 1997; see also Edney, 2004 for review). According to Diefenbach (1997), almost a third of characters with a mental illness were depicted as having committed criminal behavior. In contrast, only 3.2% of characters without a mental disorder are depicted as criminals. It is also noteworthy that criminal activity conducted by the mentally ill is more likely occur on TV than in the real world. As previously indicated, Diefenbach found that approximately one third of the TV characters that had a mental illness were portrayed as being criminal offenders. In contrast, only 2-4% of people with a mental disorder will, in fact, commit a criminal act (Diefenbach, 1997). It is important to note that these inaccurate depictions are not restricted to adult programming. Recently, Stuart (2006) reported that even children are exposed, at a very young age, to negative and inaccurate mental health portrayals. She suggests that the extensive and long-term exposure to television across the lifespan likely contributes to the development of stigmatizing attitudes toward those who are suffering from mental illness. That is, she argues that repeated exposure to largely negative and inaccurate depictions has a cumulative and negative effect on mental health-related attitudes. In keeping with the idea that TV is an influential source that informs people’s beliefs about mental health issues, research has demonstrated that people’s attitudes and beliefs are related to how much TV they watch. For example, Granello & Pauley (2000) found that as the amount of television TV and Mental Health 6 watched increased, attitudes towards people with mental illness became more negative. Vogel and associates (2008) evaluated the predictive ability of exposure to TV comedies and dramas on help-seeking attitudes. Moreover, they investigated the extent to which stigma mediated this relationship. Their results suggested that people who watch comedy or drama more frequently were more likely to have more stigmatizing attitudes (i.e., more negative attitudes). This then predicted more negative attitudes towards treatment, resulting in less willingness to seek help. To date, research concerning the relationship between TV consumption and mental health attitudes has emphasized the quantitative aspects of TV viewing habits. However, recent research suggests that the influence of TV on health attitudes more generally may not be simply a matter of how much TV someone watches; rather, the influence may depend, in part, upon the degree to which someone becomes psychologically involved with the shows that s/he watches (Bahk, 2001). Bahk has identified three dimensions of psychological involvement that can influence health-related attitudes and beliefs: a) media involvement, b) perceived realism; and c) role identification. Moreover, his research suggests that all three of these factors contribute to the impact of media on our attitudes. According to Bahk (2001), the concept of media involvement is complex and reflects three factors. First, he suggests that an individual’s level of involvement will be dependent upon the specific characteristics of the media presentation. For example, the more exciting a presentation is, the greater the individual’s involvement will be. He also argues that involvement can be influenced by the personality and pre-existing attitudes of the viewer. For TV and Mental Health 7 example, people described as more empathetic may be more inclined to become involved in drama presentations than would people with less empathetic tendencies. Finally, involvement is also a function of situation-specific elements that are being experienced by the viewer (e.g., imminent needs, motives, distractions). Accordingly, this concept is concerned with more than just ‘in the moment’ involvement and includes behaviors that occur before (e.g., being available to watch TV), during (e.g., allowing for limited distractions) and after (e.g., discussions with co-workers) watching any given TV show. Perceived realism is defined as the extent to which the viewer believes that the content of what s/he is viewing is likely to happen or be seen in the real world (Bahk, 2001). This concept is constrained to when the viewer is actively watching TV. Bahk also operationalized Role Identification as the degree to which the viewer of a dramatic presentation associates and identifies with a role character. Again, this concept is restricted to when a viewer is watching TV. The influence of psychological involvement on mental health-related attitudes specifically has not been examined to date. That is, Bahk (2001) demonstrated that the level of psychological involvement experienced while watching a dramatic movie about a deadly virus was correlated with healthrelated locus of control. Accordingly, it is important to determine whether or not a similar relationship between psychological involvement and mental health-related attitudes and beliefs exists. The present study serves to extend the current understanding of the relationship between TV viewing habits and mental health attitudes by concurrently evaluating both the traditional, quantitative measures of TV viewing habits and psychological aspects of these experiences. To this end, TV and Mental Health 8 psychological involvement was assessed in relationship to TV viewing habits. Specifically, the extent to which the three dimensions identified by Bahk (2001) correlated with mental health-related attitudes was examined. A second limitation of the extant research is that most of it is correlational in nature. Limited research has examined the direct impact of watching TV. One exception is a study conducted by Wahl and Lefkowits (1989) who looked for changes in attitudes in participants after watching one of two made-for-TV movies. Two of the groups watched a movie containing content related to mental health/disorders. These two groups differed in that one was shown a trailer advising the viewing audience that violence is not common in the mentally ill population. The third group saw a different movie and served as the control group. Participants who saw the mental health movie (with and without the trailer) reported significantly more negative attitudes towards those suffering from mental health disorders, relative to those who viewed the control movie. Interestingly, there was no effect of the trailer. While these results suggest that TV content can affect attitudes directly, this study only compared attitudes across the groups after viewing the episode. That is, attitudes were not assessed in advance of watching the movies. As such, it is possible that pre-existing differences in attitudes accounted for the observed post-viewing differences. Finally, it has also been suggested that knowledge about mental health disorders that was gained through formal education and/or training can influence related attitudes. Addison and Thorpe (2004) found that those participants with more accurate knowledge of mental illness displayed more positive attitudes towards those suffering from mental health disorders. TV and Mental Health 9 Angermeyer and Matschinger (1996) examined the influence of knowledge gained through familiarity and experience with mental health issues on attitudes. They found that respondents who were more familiar with mental health disorders (e.g., had more personal contact with sufferers of mental illness through friends, family, co-workers, etc.), were more likely to express more positive attitudes towards those suffering from mental health-related problems. However, they suggested that it might not be the extent of the exposure, but just whether or not they have been exposed to these personal experiences. The present study assessed mental health-related attitudes at two points in time in order to further evaluate the nature of the relationship between TV viewing habits and experiences, and attitudes about mental health/disorders. Specifically, the present study first evaluated the relationship between both quantitative and psychological aspects of TV viewing habits and attitudes about mental health/disorders. Subsequently, the acute effects of watching specific TV episodes on attitudes about mental health/disorders were evaluated. To this end, participants watched one of three selected episodes of a popular medical drama TV series. Two of the episodes included a major storyline that concerned a mental health disorder. These two episodes differed, however, in terms of the affective tone of the storyline. That is, one episode was more negative in it’s depiction and outlook while the other episode was more positive. Thus, the present study addressed two research questions: 1) Are the amount of TV watched and the degree of psychological involvement important variables in determining people’s attitudes and beliefs about mental illness? If so, are they differentially important in this relationship? 2) Does viewing an episode with a TV and Mental Health 10 mental health storyline have an acute effect on attitudes towards mental health? Further, does the affective tone of the mental health storyline differentially influence mental health attitudes? That is, would a positively toned episode influence attitudes to become more positive, and conversely, would a negatively toned episode influence attitudes to become more negative? Pilot Study The effects of TV on attitudes, in general, are complex and multidetermined. The purpose of the present research was to determine the specific effects of storyline on mental health-related attitudes. To this end, we wanted to compare a TV episode that had a strong MH storyline with one that did not. However, as suggested above, it is important to note that MH storylines can vary greatly. For example, shows can differ in their tone, or affective valence. That is, some shows are very positive in their portrayals of MH/D while other shows focus upon more negative aspects of MH/D. In order to determine if the storyline and affective tone of a MH-related storyline can influence peoples’ attitudes and beliefs about MH/D, it is imperative that the episodes to be used be carefully selected. In order to maximize the likelihood of detecting such effects, it is important that the selected episodes differ in terms of the specific variables of interest (i.e., storyline and affective tone), but are comparable in as many other regards (e.g., interest level, emotional intensity, perceived realism, etc.) as possible. A pilot study was conducted to ensure that the episodes selected for use in the main study of this thesis were appropriate. Before describing the pilot study, a brief description of the steps taken to select the specific episodes to be TV and Mental Health 11 used is provided. First, it was decided that episodes from a single season of a TV drama serial show would be used since dramas are more likely to contain mental healthrelated storylines (Signoreilli, 1989; Diefenbach, 1997). Moreover, this is a popular genre in primetime TV (Statistics Canada, 2006). It is also noteworthy that use of episodes from a single series and season serves to maximize the consistency in the main cast and screenwriting across the episodes. Multiple episodes from several different medical drama series were examined. Given Bahk’s (2001) research, it was important to ensure that the selected episodes were engaging. Accordingly, relatively recent TV episodes were considered for use as current TV shows may be more likely to have a greater number of viewers than older TV shows. As well, participants may find the topics, language and presentation styles of current TV more engaging. Furthermore, the portrayal of MH disorders may be more reflective of current views and perceptions, making them more relevant to the present study. Ultimately, episodes from the seventh season of “ER” were selected and reviewed in greater detail. This decision was based, in part, on the popularity and longevity of the series (e.g., ER just completed it’s 14th season). Given the demographics of university students, the population to be studied, it was unlikely that participants would have seen the selected episodes or, if the episodes had been previously seen, they would be less likely to have been viewed recently or be well remembered. Additionally, ER and multiple cast members have been nominated and received numerous awards (IMDB Database, 2008). Finally, episode synopses (Geocities, 2000) indicated that the seventh season included TV and Mental Health 12 several episodes starring Sally Field whose character was portrayed as having a mental illness. Moreover, she received an Emmy award for this role, suggesting that her portrayal of her character was compelling. In consultation with the project supervisor, 3 episodes were ultimately selected (see Appendix A for synopses). The main storyline of two of the episodes concerned mental health issues while none of the storylines included in the third episode did. The two "mental health" episodes were judged to differ in terms of the affective tone (or valence) of the storyline. That is, one episode was thought to be more positive in its outlook (MH+) than the other (MH-). However, these episodes were consistent in the amount of focus on the MH-related storyline and both involved the same characters and the same disorder. All three episodes seemed to hold the same levels of interest and emotional intensity. As well, the characters themselves seemed well developed and interesting. Method Participants Participants (n = 34) were undergraduate psychology students who had been recruited primarily through the use of SONA, the psychology department’s internet-based volunteer subject pool. Class announcements were also made in a number of psychology classes. All participants were 19 years of age or older, were relatively fluent in English and able to read and write English at a minimum of the Grade seven level. The majority of participants (n = 32) were Caucasian) Participants were randomly assigned to watch one of the three selected ER episodes: the control episode (CTRL; n = 12, including one male), the mental health episode with a negative tone (MH-; n = 12, including one male), and the TV and Mental Health 13 mental health episode with a positive tone (MH+; n = 10, including three males). As indicated in Table 1, the three groups were found to be similar in terms of age and education. Table 1 Demographic characteristics (mean ± SD) of the three groups. Control MH- MH+ Age 21.9 ± 3.4 23.3 ± 5.9 22.8 ± 4.5 Education* 3.0 ± .95 2.83 ± 1.0 2.9 ± .88 * years of university education Materials and Apparatus Testing was conducted in groups of two to six participants, or individually, depending upon the availability of participants. All sessions were conducted in a designated research space. A computer, LCD projector and screen were utilized. A commercial-free DVD version of the three episodes of ER was used. All episodes were from the 7th season of ER (i.e., CTRL = Episode 10; MH- = Episode 6, and MH+ = Episode 21). Measures To help characterize the sample, participants were asked to provide basic demographic information. This included age, sex, education, marital status & ethnic background. To determine perceptions and reactions to the viewed episode, participants were asked several questions concerning the content of the episode and the TV and Mental Health 14 psychological involvement experienced while watching the episode (see Appendix B). This measure was developed for this study. First, participants were asked to describe the main storylines. Subsequent questions were modeled after the three aspects of Bahk’s (2001) proposed concept of psychological involvement (i.e., perceived realism, media involvement and role identification). The participants’ responses demonstrated the strength of their perceived psychological involvement within the three categories. Most questions consisted of two parts. First, participants were asked to indicate their responses using a 5point Likert-type scale (e.g., 0 = not really, 5 = very). Secondly, participants were asked to describe the basis for each of their ratings. These comments provided qualitative information about what the participant was considering when answering the questions. Procedure At the beginning of the session, participants were presented with the consent form in which the procedures and ethical issues (e.g., confidentiality, and potential risks/benefits, etc.) were described (see Appendix C). The researcher reviewed the form with participants and answered any questions the participants had. Once informed consent was obtained, the selected episode was presented. After viewing the episode, participants completed the questionnaire packet. Test sessions were a maximum of 60 minutes in duration. Results and Discussion Across the 3 episodes, 22 of the 34 participants reported having watched the series previously. However, only five reported having seen the specific episode before. Given the popularity of ER these results may by somewhat lower TV and Mental Health 15 than expected. However, as described above, this may ultimately enhance the likelihood of detecting acute effects. Overall, participants indicated that they were only somewhat likely to watch the next episode and somewhat less likely to watch the series on a regular basis. One-way analysis of variance (ANOVA) did not yield any group differences (see Table 2). Overall, participants accurately described the main storylines of the various episodes. These descriptions were consistent with both the episode synopses and with the descriptions established by the researchers upon viewing the selected episodes. Examination of the responses confirmed the predicted differences in the episodes. That is, only two of the three episodes were described as including major storylines that pertained to psychological disorders. In addition, the two MH episodes differed in their affective tone. Specifically, the MH- episode was consistently described as being more negative than the MH+ episode. It is important to note that three participants who viewed the CTRL episode suggested that a very brief scene in which one of the main characters (a doctor) refused to see the Psychiatrist could be perceived as negative. Although this represented a minority of participants, the comments were specific and worded strongly. No other scenes were identified by any of the participants as containing MH content. TV and Mental Health 16 Table 2 Mean ± Standard Deviation, Range of Scores and Statistical Results for Pilot Study Questionnaire Episode Question* CTRL MH- MH+ ANOVA Statistics 12. Next episode? 1.6 ± 1.6 0-4 1.9 ± 1.4 0-4 2.6 ± 1.4 0-4 F (2,31) = 1.35, p > .10 13. Regular basis? 1.3 ± 1.3 0-3 1.7 ± 1.5 0-4 2.3 ± 1.2 0-4 F(2,31) = 1.45, p > .10 2. Interest (episode)? 3.2 ± .72 2-4 3.3 ± .49 3-4 3.6 ± .52 3-4 F (2,31) - 1.49, p > .10 7. Interest (character)? 2.9 ± .67 2-4 3.1 ± .79 2-4 3.4 ± .70 2-4 F (2,31) = 1.24, p > .10 3. Concentrate? 3.1 ± 1.0 2-4 3.3 ± .65 2-4 3.4 ± .70 2-4 F<1 4. Realistic (episode)? 3.0 ± .95 1-4 2.8 ± .72 2-4 3.1 ± .74 2-4 F<1 9. Realistic (MH)? 2.5 ± .64 2-4 2.8 ± 1.1 0-4 2.8 ± .92 1-4 F<1 5. Dramatic? 3.0 ± 1.0 1-4 3.5 ± .52 3-4 3.4 ± 1.0 1-4 F (2,30) = 1.13, p > .10 6. Emotional? 2.8 ± 1.5 3-4 3.8 ± .45 3-4 3.6 ± .52 3-4 F (2,31) = 3.13, p = .06 10. MH attitudes? 0.5 ± .67 0-2 1.0 ± 1.2 0-3 2.3 ± 1.6 0-4 F(2,31) = 6.64, p = .004 11. Treatment attitudes? 1.6 ± 1.3 0-4 1.4 ± 1.5 0-4 1.2 ± 1.2 0-3 F<1 * see Appendix B for complete phrasing of questions TV and Mental Health 17 Quantitative data were analyzed using a series of one-way Analysis of Variance (ANOVA). It is important to note that for each of the objectively scored questions, the full range of possible responses was observed (see Table 2). No significant differences were found across the episodes with regards to interest, level of drama, or perceived realism, suggesting that the episodes were comparable on these control variables (Table 2). When looking specifically at the levels of interest within the episode, both overall and specific to the character, results suggest that the episodes did not differ on this variable. All three episodes were found to be very interesting as reflected in overall average scores across the participants and ranges that were restricted to the higher end of the rating scale. There was, however, a non-significant trend towards group differences in regards to the emotionality of the various episodes. That is, the two MH episodes were rated as being slightly more emotional than the CTRL episode (see Table 2). Given that the participants were all psychology students, this finding is not especially surprising. Two questions were asked about the effects of the episodes on mental health-related attitudes. Interestingly, significant group differences were evident when participants were asked to indicate the extent to which their attitudes about people with mental health disorders were affected by the viewed episode (see Table 2). Tukey’s HSD post hoc tests (∝ = .05) revealed that the MH- and CTRL groups did not differ significantly from one another. Moreover, inspection of the group means and standard deviations suggest that participants' attitudes were at most mildly affected by either of these two episodes. In contrast, the group who viewed the MH+ episode differed significantly from both the CTRL and MH- TV and Mental Health 18 groups. Moreover, these participants reported that their attitudes were, on average, moderately affected by the episode. It should be noted that participants were not asked to indicate the direction of the reported change in attitudes (i.e., positive or negative). However, review of the comments provided (n = 8) suggested that several (n = 4) of those who viewed the MH+ episode experienced a positive shift in attitude. That is, they described a greater need for empathy and support for people with MH disorders. For those viewing the other episodes, very few comments were made. Moreover, none of the comments suggested that the episode had influenced their perceptions, attitudes or beliefs. In contrast, when participants were asked to report whether their attitudes or beliefs about treatment for a mental health problem had been affected, no significant differences were found between the groups. Moreover, all three groups reported that, on average, their attitudes had changed only slightly. Taken together, it is evident that the three episodes were remarkably similar in terms of most of the identified control variables. Moreover, the episodes were perceived to be different, as expected, in terms of their main storylines. Specifically, only two of the three episodes included a main storyline that addressed issues related to mental health disorder. Moreover, the two MH episodes were consistently described as being different in their affective tone. As such, it was concluded that the selected episodes are largely suitable for use in the main study. However, while the CTRL episode did not include a main storyline that related to a mental disorder, it did include a brief scene that involved a comment about psychiatric treatment. The inclusion of such a scene TV and Mental Health 19 could be potentially problematic. That is, this scene could itself affect the attitudes and beliefs of some individuals. To be conservative, it was decided that this scene should be deleted from the version to be used in the full study Main Study The present study addressed two research questions: 1) Are people’s attitudes and beliefs about mental illness related to their TV viewing habits and experiences? Two approaches to measuring TV viewing habits were used. First, several quantitative variables (e.g., hours of TV watched/week) were examined. Secondly, the level of psychological involvement experienced in regards to a favorite TV drama series was assessed. The extent to which these two categories are differentially related to attitudes was evaluated. 2) Does viewing a single episode with a mental health storyline have an acute effect on attitudes about mental health/disorders? To this end, episodes that included a major storyline related to a mental health disorder were compared to an episode that did not have any mental health-related storylines. In addition, the extent to which the affective tone of the mental health storyline might differentially influence mental health attitudes was also evaluated. That is, would viewing a positively toned episode result in attitudes becoming more positive, and conversely, would a negatively toned episode lead to attitudes becoming more negative? Method Participants Methods of recruitment were similar to those used for the pilot study. One person did not complete both sessions. As such, the data from this participant TV and Mental Health 20 were excluded from all analyses. The remaining participants (n = 48) were assigned to one of three groups (i.e., CTRL, MH-, and MH+) such that the groups were approximately matched in terms of number and sex of participant. The CTRL and the MH- groups consisted of five males and 11 females whereas the MH+ group consisted of six males and 10 females. It should be noted that 3 participants had viewed the CTRL episode as part of the pilot study. These participants were assigned to either the MH- or MH+ condition. The majority (n = 45) of participants were Caucasian and single (n = 40). All participants were relatively fluent in English and were able to read and write English at the Grade seven level or above. As indicated in Table 3, the three groups were similar in terms of age and education. With one exception, all participants were currently taking at least one psychology course. 43% were upper level students (n = 21). Table 3 Demographic characteristics (mean ± SD) of the three groups. CTRL MH- MH+ Age 21.2 ± 2.9 22.3 ± 4.7 22.9 ± 3.6 Education* 2.4 ± 1.2 2.7 ± .70 3.1 ± 1.4 * years of university education Materials and Apparatus All sessions were conducted in a designated research space. A computer, LCD projector and screen were utilized. A commercial-free DVD version was TV and Mental Health 21 used of the three episodes of ER. The selected episodes (i.e., 6, 10 & 21) were from the 7th season. As described previously, one scene from the CTRL episode was removed. Measures This thesis was part of a larger-scale study that included multiple measures of mental health attitudes. In addition, measures of several potential moderator variables were used. Only a subset of the measures is described here. Measures that were not part of the thesis included: the Nunnally Knowledge Questionnaire (NKQ), the Mental Health Inventory (MHI), the Current Health Status Questionnaire (CHS), and the Indirect Measure of Attitudes (IMA). These measures are described in Appendix D. A brief demographic questionnaire was used to characterize the sample. It included items concerning age, sex, ethnicity, level of education and marital status (see Appendix E). To measure attitudes about mental illness, the Community Attitudes towards Mental Illness questionnaire (CAMI; Taylor & Dear, 1981) was used. The CAMI consists of 40 statements that participants indicate their level of agreement using a 5-point Likert-type scale (e.g., 1 = Strongly Agree, 5 = Strongly Disagree) (see Appendix E). Higher scores indicated more positive attitudes towards mental illness. Together, the items comprised four categories of commonly held attitudes (examples provided following the definitions are sample questions): Authoritarianism (Auth) concerns the belief that people suffering from mental illness need control or discipline (e.g., As soon as a person shows signs of mental disturbances s/he should be hospitalized). Benevolence (Ben) measures TV and Mental Health 22 whether one believes that the mentally ill deserve more tolerant and sympathetic attitudes and support (e.g., More tax money should be spent on the care and treatment of the mentally ill). Social Restrictiveness (SocRes) assesses beliefs about the social rights of individuals with mental illness (e.g., The mentally ill should not be isolated from the rest of the community). Finally, Community Mental Health Ideologies (CMHI) assesses the beliefs that mental health resources should be community based and located within the local communities (e.g., The best therapy for many mental patients is to be part of a normal community). Half of the questions for each of the four subscales were reverse scored (see Authoritarianism example). The Level of Familiarity Questionnaire (LFQ; Holmes, et al., 1999) (see Appendix E) was used to measure participants’ knowledge and experiences with mental illness. It consists of 11 statements regarding possible experiences with someone suffering from a mental illness. Items range from experiences involving indirect contact with mental illness (e.g., I have watched a movie or television show in which a character depicted a person with mental illness) to experiences that involve more direct contact with mental illness (e.g., I live with a person who has a severe mental illness). Participants were asked to indicate with a check mark all of the experiences they have had. Scores reflect the highest level, or most direct, of personal contact indicated by the participant. The Television Usage and Behaviors Evaluation (TUBE) was developed by the researchers for this study (see Appendix E), and is based upon the Media Attitudes and Behaviors Inventory (Szostak & Webster, in prep). There are two forms to this measure. The first form, TUBE I, assesses both quantitative (e.g., TV and Mental Health 23 number of hours watched) and psychological aspects of participants’ general viewing habits and preferences. Specifically, the three dimensions of psychological involvement described by Bahk (2001) (i.e., media involvement, perceived realism, and role identification) were assessed using 33 questions. Response options vary across questions. However, for most questions, participants are asked to indicate their responses using a 5-point Likert-type scale. Participants answered these questions in relation to several different genres of TV shows (e.g., drama, comedy, etc.). However, for the purposes of this thesis, only responses specific to the genre of drama are considered. Specifically, participants answered the questions in relation to their favorite TV drama series. Perceptions of and reactions to the specific episode viewed by participants in Session II were assessed utilizing the second form of the TUBE (TUBE II, see Appendix E). It consists of 31 questions designed to assess interest level, emotional intensity, perceived realism, and role identification (Bahk, 2001). For most questions, participants were asked to indicate their responses using a 5point Likert-type scale. However, response options varied as a function of the specific question. To confirm that the storylines of the three episodes were perceived to be distinct in regards to content and affective tone, the TUBE II also included open-ended questions that addressed the content of the storylines and the characters from the specific episode that participants had just viewed. Procedure Testing was conducted in groups of two to six participants, or individually, depending upon the availability of participants. As indicated previously, this study TV and Mental Health 24 consisted of two sessions. The first session was approximately 50 minutes in length, while the second session lasted approximately 70 minutes. Session II occurred, on average, 7.6 (± 2.3) days after completion of Session I (range: 5 to15 days). Session I The session commenced with the researcher presenting a brief overview of the purpose of the project, research procedures and distribution of bonus credits (if applicable). Participants were then asked to read the consent form in which confidentiality, and possible risks/benefits were further described. The session commenced once the participants had signed the consent form During Session I, participants completed a set of six questionnaires, the demographic questionnaire, the LFQ, the CAMI, the TUBE I, the NKQ and the MHI. To partially control for possible order effects, questionnaires were presented in 5 different orders (see Appendix F). All participants completed the demographic questionnaire first. Once all participants had completed the session, individual Research Identity Numbers (RID) were copied onto all of the pages of each questionnaire packet. The consent form was removed and stored separately, such that they were accessible only by the project supervisor. In order to assess potential changes in attitudes across Session I and Session II, it was important to ensure that the two sets of questionnaires completed by each participant could be matched up once completed. To ensure that the right Session II questionnaire set was provided to the right participant, the RID was copied onto a blank set of Session II questionnaires. Names were temporarily attached using post-it notes. TV and Mental Health 25 These labeled packets were stored in a locked cabinet. Notes were removed and discarded once the questionnaire had been given to the appropriate participant. Session II During the second session, informed consent was re-affirmed verbally. Participants were then shown one of the three possible episodes of ER. Immediately following the episode, participants were asked to complete several questionnaires, including the CAMI, NKQ, CHS, TUBE II and IMA. To control for possible order effects, two different questionnaire packets were utilized (see Appendix F). Specifically, they differed in terms of the order of two objective measures of mental-health attitudes and knowledge (i.e., CAMI and NKQ, respectively). The two packets were counter-balanced across participants, such that half of the participants received the CAMI first, while the other half competed the NKQ first. The TUBE II and the CHS, in that order, always followed the CAMI and NKQ. The media measure was completed after the two attitude measures so as not to bias the participants’ answers regarding their attitudes and beliefs about mental health disorders. Since the IMA was added part way through the study, it was added to the end of the questionnaire packet so as not to change the order of the remaining participants. Results Research Question 1: Are quantitative and psychological aspects of TV viewing habits related to attitudes about mental health/disorders? Before considering the inter-relationships between TV viewing habits and mental health-related experiences and attitudes, the descriptive results of the two individual classes of variables will be presented. Since the TUBE was created TV and Mental Health 26 for this study, it is necessary to first evaluate the psychometric properties of this measure. Psychometric Properties of the TUBE I. In order to determine if the TUBE I items that were intended to tap the concept of psychological involvement are inter-related, a series of bivariate correlations were conducted. Since not all participants answered the mental health (MH) items on the TUBE I, these seven items were analyzed separately. The results indicated that 23% (n = 54) of the non-mental health pairs of items were moderately to strongly inter-related (.30 < r < .65, all p’s < .05; see Table 4). Similarly, 100% of the seven MH-related items (n = 21) were moderately to strongly inter-correlated (.41 < r < .71, all p’s < .01; see Table 5). Together, these results suggest that it is appropriate to conduct exploratory factor analyses to clarify the nature of these various relationships. A Principal Components Analysis (PCA) was conducted on the 22 non-MH questions. Initially, the un-rotated, orthogonal model was examined. Both the Kaiser-Meyer-Olkin test of sampling adequacy (KMO; .59) and Bartlett’s test for Sphericity (383.46, df=190, p < .001) indicated that the data are suitable to be analyzed using factor analytic procedures. To determine the optimal number of components, three main criteria were considered. Components had to have an Eigenvalue > 1. The breakpoint of the curve in the scree plot was also considered (see Figure 1). In addition, components had to be considered stable. That is components had to consist of at least three items (Zwick & Velicer, 1986) and each item had to load uniquely on that component. In order to satisfy this last TV and Mental Health 27 Table 4 Intercorrelations for TUBE I non MH-related items 2 3 4 5 6 7 8 9 10 11 1. PInvolve3 .36* .49** .07 .10 .38* .30* .55** .18 .05 .03 2. PInvolve4 1 .12 .12 .24 .22 .05 .41** .05 .12 -.05 3. PInvolve5 - 1 .32* .36* .56** .39** .44** .38* .14 .15 4. PInvolve6 - - 1 .29 .27 .17 .24 .19 .26 .03 5. PInvolve7 - - - 1 .40** .42** .25 .20 .18 .15 6. PInvolve8 - - - - 1 .64** .54** .18 .16 .06 7. PInvolve9 - - - - - 1 .47** .165 .22 .03 8. PInvolve10 - - - - - - 1 .24 .08 -.11 9. Realism12 - - - - - - - 1 .44** .57** 10. Realism 13 - - - - - - - - 1 .45** 11. Realism14 - - - - - - - - - 1 12 13 14 15 20 21 22 1. PInvolve3 .13 .04 .01 .00 .06 -.04 .14 .20 .01 -.05 .334* 2. PInvolve4 .06 -.12 .22 .07 .14 .07 .02 .07 .05 .29 .29 3. PInvolve5 .18 .15 .17 .12 .36* .41** -.06 .19 .28 -.38* .42** 4. PInvolve6 .17 .02 .26 .13 .07 .09 -.19 -.04 -.15 -.08 -.04 5. PInvolve7 .06 -.03 .22 .23 .16 .02 -.27 -.07 -.04 .02 .15 6. PInvolve8 .21 .30 .22 .16 .22 .06 -.02 .21 .18 .02 .52** 7. PInvolve9 .17 .23 .17 .04 .14 .05 -.08 .16 .16 .11 .37* 8. PInvolve10 .037 .00 .04 .03 .27 .16 .00 .12 .20 .05 .17 9. Realism12 .50** .31* .42** .51** .19 .09 .08 .18 -.11 .03 -.06 10. Realism13 .45** .44** .45** .43** .24 .09 -.06 .13 -.05 .05 -.01 11. Realism14 .47** .37* .43** .46** .01 -.05 .16 .18 -.11 .06 -.03 12. Realism15 1 .61** .62** .58** .04 -.08 .02 .09 -.32* -.11 -.07 13. Realism16 - 1 .48** .56** .15 .10 -.11 .23 .13 -.11 .18 14. Realism 17 - - 1 .65** -.07 -.03 -.33 -.20 -.30 -.01 .06 15. Realism18 - - - 1 .08 .10 -.22 -.12 -.17 -.01 -.03 16. RoleID27 - - - - 1 .70** .36* .53** .49** .04 .07 17. RoleID28 - - - - - 1 .13 .26 .40** -.12 .05 18. RoleID29 - - - - - - 1 .59** .28 .34* -.19 19. RoleID30 - - - - - - - 1 .51** .26 .13 20. RoleID31 - - - - - - - - 1 .13 .28 21. RoleID 32 - - - - - - - - - 1 -.06 22. RoleID33 - - - - - - - - - - 1 Note. 2-tailed tests; *p < .05; ** p < .01 16 17 18 19 TV and Mental Health 28 Table 5. Intercorrelations for TUBE I MH-related items 2 3 4 5 6 7 1. MH19 .45** .70** .58** .41** .49** .60** 2. MH20 1 .69** .58** .57** .49** .55** 3. MH21 - 1 .59** .52** .60** .58** 4. MH22 - - 1 .63** .63** .63** 5. MH23 - - - 1 .71** .59** 6. MH24 - - - - 1 .63** 7. MH25 - - - - - 1 Note. 2-tailed tests; *p < .05; ** p < .01 criterion, items had to have a component loading > .32 and there had to be at least a .1 difference between the loadings on the various components. To ensure determination of the optimal model, the data were also analyzed using a varimax rotation. After examining both the rotated and un-rotated models in relation to the above criteria, it was determined that the best fitting model was a three factor rotated model, with 2 items being removed (see Table 6). One of the removed items (Question 4) pertained to participation in websites and blogs associated with the participant’s favorite drama show was dropped as it loaded on multiple factors. The second item (Question 6) assessed the extent to which the participant was likely to engage in discussions with friends, co-workers, or family about a missed episode. This question was excluded as it did not meet the minimum loading criteria. It is important to note that the final model was congruent with the theory-based development of the TUBE. All items loaded on the predicted components, as suggested by Bahk’s (2001) research. That is, the TV and Mental Health 29 three components could be interpreted as reflecting Perceived Realism (PR; n = 7), Media Involvement (MI; n = 7), and Role Identification (RI; n = 6). Each component accounted for 22.6%, 17.3% and 12.4% of the variance, respectively, for a total of 52.3%. The fact that the best model was based upon varimax rotation procedures indicates that these components are not independent. Number of Factors Extracted Figure 1. Scree plot for the Principal Components Analysis of the non mental-health items from the TUBE I. TV and Mental Health 30 Table 6 Principal Components Analysis of TUBE I - Final Model Item* Component Perceived Realism Media Involvement Role Identification 15. How realistic are the characters? .81 -.01 -.10 18. How realistic are the professional interactions … .80 .01 -.11 17. How realistic are the characters’ personal interactions? .77 .11 -.29 14. How realistic are the outcomes? .74 -.07 .11 12. Overall, how realistic is this TV series? .70 .13 .11 13. How realistic are the set locations? .70 .12 .14 16. How realistic are the attitudes of the characters? .69 .13 .04 8. How often do you talk about this television show … .15 .79 .07 5. How often do you think about the storyline of the show … .17 .75 .22 9. How likely are you to make sure that you are available … .10 .71 -.03 10. How often do you record or download the show … -.04 .68 .11 33. How often do you think about this character … -.07 .65 .02 3. How often have you downloaded episodes or … -.02 .57 .01 7. How often have you missed work or changed your work … .19 .53 -.10 30. How closely do you identify with … current work situation? .07 .08 .80 27. Overall, how closely do you identify with this character? .13 .25 .76 29. To what extent do you identify with his/her occupation? -.09 -.31 .68 31. How closely do you identify with his/her current personal … -.25 .25 .66 28. How closely do you identify with his/her personality? .05 .19 .59 .01 -.17 .39 32. To what extent do you want to work in the same occupation … Note. * see Appendix E for complete phrasing of questions The seven mental health-related questions were subjected to a separate PCA, using the same criteria. This analysis resulted in all seven items converging on a single factor that accounted for 65.8% of the variance (see Table 7). After TV and Mental Health 31 reviewing the item questions, this component was best conceptualized, and labeled, as Perceived Realism / Mental Health (PR/MH). Table 7 Component loadings for the MH items of the TUBE I – Final Model Component Item* Perceived Realism / Mental Health 21. How realistic are the associated outcomes? .84 22. How realistic are the characters …? .83 25. How realistic are the interactions that occur … professionals …? .82 24. How realistic are the interactions that occur … friends/family? .82 20. How realistic are the depictions …? .80 23. How realistic are the attitudes of the characters …? .80 19. Overall, how realistic were these storylines? .76 * see Appendix E for complete phrasing of questions To further examine the nature of the four components resulting from the two PCA’s, Pearson correlations were conducted on the four factor scores. Subscale scores were calculated by summing the items that loaded on each component and dividing by the number of items comprising that factor. As such, each score could range in value from 0 – 4, with higher scores indicating greater perceived realism, both in general and specific to MH-related content, media involvement, and role identification. All three main factors were all positively correlated with each other (see Table 8). PR/MH was also correlated with all three of the main factors, the strongest correlation being with PR. This suggests that the more people believe that their favorite drama TV series is realistically TV and Mental Health 32 portrayed then the more likely they are to believe that mental health aspects of the show are also realistic. These results also suggest that that the more committed people are to their favorite TV drama show and the more people identify with a role character, the more likely it is that they will believe that mental health issues are portrayed more realistically on TV. Table 8 Inter-correlations of the TUBE I Components PR/MH Media Involvement Role ID .72** .49** .31* PR/MH 1 .41** .28** Media Involvement - 1 .40** Role ID - - 1 Component Perceived Realism Note. 2-tailed; *p < .05. ** p < .01 TV viewing habits and styles. The TV viewing habits and styles of the current sample are summarized in Tables 9 and 10 (see also Appendix G). Overall, participants indicated that they watched an average of 9.3 (± 7.8) hours of TV per week. According to viewing times, drama was the most frequently watched genre (3.0 ± 4.7) with comedy a close second (2.4 ± 2.79) (see Table 9). However, when asked to identify their favorite genre, 44% indicated comedy as their top choice (n = 21) (see Table 10). Drama was the favorite genre for 33% (n = 16). The remaining list of genres, although diverse, were substantially less popular then the top two favorites. TV and Mental Health 33 Table 9 TUBE I – Rankings of Preferred TV Genres Favorite Genre Frequency Percent Comedy 21 43.8 Drama 16 33.3 Science Fiction 5 10.4 Reality 1 2.1 Sit Coms 1 2.1 Sports 1 2.1 All 1 2.1 Anime 1 2.1 War 1 2.1 Table 10 TUBE I – Rankings of Preferred TV Genres Favorite Genre Frequency Percent Comedy 21 43.8 Drama 16 33.3 Science Fiction 5 10.4 Reality 1 2.1 Sit Coms 1 2.1 Sports 1 2.1 All 1 2.1 Anime 1 2.1 War 1 2.1 Participants were also asked to identify their top three drama shows on TV (not necessarily rank ordered). Of the 116 responses provided, 37 different TV shows were listed (see Appendix G for complete list). These ranged from crimebased to medical and legal-focused dramas. However, the most frequently cited shows were CSI (n = 18), House (n = 16), and Grey’s Anatomy (n = 12). These TV and Mental Health 34 three shows, accounted for 40% of the total number of responses provided. Taken together, the diverse nature of TV drama series is evident. It is also apparent that the present sample is heterogeneous in terms of the types of drama TV that they watch regularly on TV. The means, standard deviations, and ranges of the four scales of psychological involvement derived from the TUBE I are presented in Table 11. First, it is important to note that for each of the scales, almost the full range of possible scores was observed. Given that items were responded to using 5-point Likert-type scales (e.g., 0 = not realistic; 4 = very realistic), the mean for PR suggests that participants believed that their favorite TV drama was moderately realistic. MH-related issues were also deemed to be moderately realistic. Participants, on average, were found to be only somewhat involved. The data also suggested that responses were limited to the lower end of the rating scales, suggesting that the participants did not identify strongly with their favorite character. Table 11 TUBE I – Levels of Psychological Involvement in Favorite Drama TV show TUBE I Component Mean SD Range Perceived Realism 2.1 1.0 0 - 3.7 Media Involvement 1.5 1.0 0 - 3.4 Role Identification 1.0 0.80 0 - 2.5 Perceived Realism/ Mental Health 1.9 1.0 0 - 3.6 Note. N = 48 TV and Mental Health 35 Pearson product-moment tests of correlation were conducted to evaluate the inter-relationships between the quantitative measures of TV viewing habits and the 4 scales of psychological involvement (Table 12). No significant relationships were found between the quantitative measures of TV viewing habits and measures of psychological involvement (all p’s > .05). This suggests that the amount of TV that one watches is not related to psychological involvement in what is watched on TV. Table 12 TUBE I - Correlation between Total TV, Total Drama and the Three Components of Psychological Involvement MI RoleID PR/MH Total TV Total Drama Perceived Realism .49** .31* .72** .14 .16 Media Involvement 1 .40** .41** .05 .01 Role ID - 1 .28 -.05 .06 Perceived Realism / Mental Health - - 1 .13 .13 Total TV - - - 1 .79** Total Drama - - - - 1 Note. 2-tailed *p < .05. ** p < .01 Mental health-related experiences and attitudes. Participants’ level of experience with mental illness was assessed using the LFQ (see Table 13). Whereas 77% of participants reported some direct personal experience with mental illness (e.g., I have a relative who has a severe mental illness, or, I have a severe mental illness), 21% of the sample specified that their experiences were predominantly media based. TV and Mental Health 36 Table 13 Participant Levels of Direct Contact with Mental Illness LFQ Question* Percent 3. I have watched a movie or TV show … 2.1 4. I have watched a documentary on television … 4.2 5. I have observed persons with severe mental illness … 8.3 6. I have worked with a person who had a severe mental illness … 10.4 7. My job involves providing services/treatment for persons … 8.3 8. A friend of the family has a severe mental illness 20.8 9. I have a relative who has a severe mental illness 35.4 10. I live with a person who has a severe mental illness 6.3 11. I have a severe mental illness 4.2 Note. N = 48 *Refer to Appendix E for exact phrasing of questions To assess MH-related attitudes, the scores of the four subscales of the CAMI were examined (see Table 14). Overall, scores were generally restricted to the more positive response options, demonstrating that the initial attitudes of the participants were very positive. That is, while subscale scores could range between 10 and 50, the means for Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideologies subscales were all close to 40. TV and Mental Health 37 Table 14 Measurements of CAMI Attitude Sub-scales from Session I CAMI sub-scale Mean ± SD Range Authoritarianism 41.4 ± 4.62 31 – 50 Benevolence 43.3 ± 4.36 32 – 50 Social Restrictiveness 41.6 ± 4.31 31 – 49 Community Mental Health Ideologies 40.3 ± 5.54 28 – 49 Note. N = 48 In order to determine if participants’ level of experience with mental illness was associated with their related attitudes, non-parametric Spearman’s Rho tests of correlation were conducted on the LFQ scores and the four sub-scales of the CAMI (Table 15). Results yielded a positive correlation between level of experience and Benevolence, suggesting that the more direct the experience with mental illness that participants have, the more empathetic and supportive their attitudes. None of the other correlations were significant. TV and Mental Health 38 Table 15 Correlation coefficients between the four CAMI subscales and the Level Of Familiarity Questionnaire scores Auth Ben SocRes CMHI LFQ .20 .30* .15 .11 Auth 1 .66** .62** .56** Ben - 1 .60** .61** SocRes 1 1 1 .60** CMHI - - - 1 Note. Spearman’s Rho non-parametric test was used. *p < .05. ** p < .01 Relationship between TV viewing habits, MH-related experience and Attitudes. Non-parametric tests of correlation (i.e., Spearman’s rho) failed to yield any significant correlations between the LFQ scores and the TUBE I (p’s > .13). This suggests that there were no relationships with the level of direct contact experienced by the participant and their psychological involvement in TV drama shows. To determine if TV viewing habits and styles were associated with mental health attitudes, Pearson correlations were conducted on the scores from the four CAMI sub-scales, the three psychological factors from the TUBE I, and the hours of total TV and total drama watched. No significant correlations were found between the quantitative measures of TV viewing and the CAMI attitude factors (all p’s > .39). In contrast, some psychological aspects of TV viewing styles were correlated with attitudes about mental disorders (see Table 16). Specifically, TV and Mental Health 39 Perceived Realism was positively correlated with Benevolence. This suggests that the more realistic that a person believes dramatic TV presentations to be, the more sympathetic and tolerant they are of people with mental illness. It was also found that Media Involvement was positively correlated with both Benevolence and Social Restrictiveness. These results suggest that the more people are committed to the TV that they watch, the more likely they are to endorse more tolerant and sympathetic attitudes, and the less likely they are to advocate for the institutionalization for the mentally ill. Table 16 TUBE I Psychological Involvement Sub-scores Correlated with the CAMI Attitude Sub-scores MI Role ID Auth Ben SocRes CMHI Perceived Realism .49** .31* .18 .29* .15 .16 Media Involvement 1 .40** .23 .42** .28* .06 Role Identification - 1 -.12 .07 .01 -.12 Authoritarianism - - 1 .66** .65** .62** Benevolence - - - 1 .63** .61** Social Restrictiveness - - - - 1 .67** - - - 1 Community Mental Health Ideologies Note. 2-tailed; n = 48; *p < .05. ** p < .01 In summary, the present sample demonstrated diverse TV viewing habits and styles both in terms of the amount of hours watched both overall and within the genre categories. Participant’s also demonstrated variability in terms of the genres that they reported viewing, and this was reflected in the extensive list of TV and Mental Health 40 viewed TV shows (across genres) that were provided by the participants, however overall, drama and comedy were clearly more favored by this sample. Participants psychological involvement in their favorite drama TV shows was evident, however did vary across the four components. Overall levels of psychological involvement were not strong overall. Full ranges of scores were reflected in the rating scales. Overall, the sample was similar with regards to their initial attitudes measured during the first session (i.e., very positive), with overall reported attitudes being restricted to the more positive end of the rating scale. The majority of participants also reported having more direct contact with people suffering from mental health disorders. Although there were no relationships found between the qualitative variables, relationships were demonstrated between the benevolence attitude scale and both the Perceived Realism and Media Involvement components of Psychological Involvement. Limiting factors that may have contributed to the lack of relationships found ay have been the lower levels of reported TV viewing and the restricted range of attitudes as reported on the CAMI. Research question 2: Acute effects of TV on attitudes. Before the acute effects of the various episodes on MH attitudes are examined, participants’ perceptions and reactions to the selected episodes will be described. Since the TUBE was created for this study, it is necessary to first evaluate the psychometric properties of this measure. TV and Mental Health 41 Psychometric properties – TUBE II. In order to determine if the TUBE II items that were intended to tap the concept of psychological involvement are inter-related, a series of bivariate correlations were conducted. Since only participants who viewed either the MHor the MH+ episodes answered the mental health (MH) items, these seven items were analyzed separately. First, a series of Pearson product-moment tests of correlations were conducted. Results indicate that several of the non-MH items (n = 74) were moderately associated with one another (see Table 17). Similarly, all seven MHrelated items were moderately to strongly inter-correlated with one another (see Table 18). As such, it is appropriate to conduct exploratory factor analyses in order to ascertain the nature of these various relationships. The procedures and criteria used to evaluate the TUBE I were followed. Consideration of both the KMO test of sampling adequacy (.72) and Bartlett’s test for sphericity (495.21, df=153, p < .001) indicate that it is appropriate to conduct a PCA on the data. As with the TUBE I, rotated and orthogonal models were evaluated. After considering the eigenvalues, the scree plot (see Figure 2), item salience and component stability, it was determined that the best fitting model for the non-MH items consisted of 3 rotated factors. This model contained 18 items, with 2 items having being removed (see TABLE 19). One of the omitted items addressed the realism of the set locations and was removed as it loaded on multiple factors. The second item that was dropped assessed how closely the participant identified with the current personal situation of his/her favorite character within the episode as it also loaded on multiple TV and Mental Health 42 Table 17 Intercorrelations for TUBE II non MH-related items 2 3 4 5 6 7 8 9 10 11 .65** .37** .49** .20 .11 .31* .34* .22 .33* .32* 2. intensely 1 .26 .36* .31* .20 .19 .14 .16 .26 .28 3. dramatic - 1 .53** .05 -.17 .27 .03 .15 .10 .02 4. emotional - - 1 .38** .07 .37* .34* .25 .25 .05 5. realistic1 - - - 1 .44** .60** .61** .47** .57** .47** 6. realistic2 - - - - 1 .25 .37** .22 .34* .22 7. realistic3 - - - - - 1 .49** .41** .43** .34* 8. realistic4 - - - - - - 1 .66** .69** .55** 9. realistic5 - - - - - - - 1 .61** .43** 10. realistic6 - - - - - - - - 1 .78** 11. realistic7 - - - - - - - - - 1 12 13 14 15 16 17 18 19 20 1. interesting1 .76** .23 .29* .01 .07 .35* .00 .69** .63** 2. intensely .46** .24 .38** -.11 -.05 .36* .10 .50** .54** 3. dramatic .59** -.14 -.07 -.16 -.17 .04 -.05 .19 .28 4. emotional .53** -.04 .10 -.00 .07 .23 -.06 .44** .52** 5. realistic1 .32* .38** .45** .07 .28 .20 .05 .48** .49** 6. realistic2 .14 .25 .33* .04 .12 .08 .19 .20 .21 7. realistic3 .45** .02 .11 .07 .08 .04 .14 .26 .25 8. realistic4 .46** .21 .07 .25 .17 .21 .02 .44** .42** 9. realistic5 .43** .15 .09 .02 -.09 .14 -.02 .24 .20 10. realistic6 .55** .06 .09 -.01 .16 .14 -.04 .46** .33* 11. realistic7 .37** .08 .05 -.07 .12 .03 -.12 .40** .39** 12. Interesting2 1 .15 .19 .08 .14 .28 .05 .67** .59** 13. identify1 - 1 .68** .27 .30* .40** .21 .28 .42** 14. identify2 - - 1 .13 .30* .22 .14 .43** .44** 15. Identify3 - - - .1 .48** .18 .56** .09 .11 16. Identify4 - - - - 1 .28 .15 .28 .30* 17. Identify5 - - - - - 1 .10 .18 .26 18. Identify6 - - - - - - 1 -.03 .06 19. watching1 - - - - - - - 1 .81** 20. watching2 - - - - - - - - 1 1. interesting1 TV and Mental Health Table 18 – TUBE II inter-correlations for MH related items 2 3 4 5 6 7 1. MH1 .79** .82** .77** .79** .63** .70** 2. MH2 1 .86** .84** .69** .64** .66** 3. MH3 - 1 .86** .75** .73** .73** 4. MH4 - - 1 .85** .66** .60** 5. MH5 - - - 1 .53** .58** 6. MH6 - - - - 1 .77** 7. MH7 - - - - - 1 Note. ** p < 0.01 Number of Factors Extracted Figure 2. Scree plot for non mental-health items from the TUBE II 43 TV and Mental Health 44 Table 19 Principal Components Analysis TUBE II – Final Fit for non-MH Items MI-2 Component PR-2 Role ID-2 2. How interesting was this episode to you? .84 .18 .07 29. How inclined are you to watch … series? .74 .26 .36 3. How intensely were you concentrating…? .73 .05 .11 13. How interesting were the characters…? .73 .45 -.02 28. How inclined are you to watch … episode? .73 .32 .28 5. How emotional was this episode? .65 .27 -.13 4. How dramatic was this episode? .61 .06 -.42 11. How realistic were ... personal interactions? .23 .86 .02 9. How realistic were the characters? .15 .84 .16 10. How realistic were the attitudes…? .05 .80 -.08 12. How realistic were the professional interactions…? .20 .72 .01 6. How realistic was this episode? .25 .67 .36 8. How realistic were the outcomes…? .25 .59 .00 15. Overall, how closely did you identify…? .18 .06 .75 17. How closely did you identify with the occupation…? .34 .00 .68 16. How closely did you identify with the personality…? -.14 .08 .65 20. Would you like to work in the same occupation…? .03 .12 .65 18. Did you identify with the current work situation…? -.04 -.05 .50 Item* Note. N=46. *exact phrasing of questions can be found in Appendix E factors. As with the TUBEI, the final model is congruent with the theory-based development of the TUBE. That is, the items conceptually loaded on the three components suggested through Bahk’s (2001) research, with questions grouped in the areas of Media Involvement (MI-2; n = 7), Perceived Realism (PR-2; n = 6), and Role Identification (Role ID-2; n = 5). Each component accounted for 34.6%, 13.7% and 11.1% of the variance (respectively), for a total of 59.4%. TV and Mental Health 45 The seven MH-related questions were subjected to a separate PCA using the same criteria. This analysis yielded a single factor containing all seven items that accounted for 76.7% of the total variance (see Table 20). This component was interpreted and labeled as Perceived Realism/Mental Health (PR/MH-2). TUBE II component scores were calculated by summing the items that loaded on each subscale and dividing by the total number of items on that subscale. As such, each score could range in value from 0 – 4, with higher scores indicating greater perceived realism both in general (i.e., PR-2) and specific to MH-related content (i.e., PR/MH-2), media involvement (i.e., MI-2_, and role identification (i.e., Role ID-2) (Table 21). All scales within the measure utilized a 5-point likert-type scale. Examination of the 4 subscale scores suggested that, on average, participants found the viewed episode to be Table 20 Principal Components Analysis TUBE II – Final Model for MH Items Component Perceived Realism/ Mental Health 23. How realistic … associated outcomes? .94 24. How realistic … character(s) ... mental health disorder? .92 21. How realistic ….. storylines? .90 22. How realistic … depictions of mental health disorders? .90 25. How realistic … attitudes of the character(s) …? .85 27. How realistic … interactions … professionals …? .82 26. How realistic … interactions … friends/family? .80 Note. See Appendix E for exact phrasing of questions. TV and Mental Health 46 moderately realistic, both in general (PR-2 = 1.9 ± 1.0) and in terms of the representations of MH issues (PR/MH-2 = 2.1 ± 1.4). It was also found that participants were moderately involved while watching the episode (MI-2 = 2.9 ± 0.8). However, they were only slightly less likely to relate to a specific character (RI-2 = 1.4 ± 0.8). To further examine the nature of the four sub-scales derived from the two PCA’s, Pearson product-moments tests of correlation were conducted on these scores. Only the relationship between Perceived Realism and Media Involvement was statistically significant (see Table 21). This relationship suggests that the more realistic that participant’s believed the TV episode to be, the more likely they were to be interested and involved in the episode. Table 21 TUBE II - Psychological Involvement Descriptives and Inter-correlations II Psychological Involvement Sub-scales Mean ± SD (Range) Perceived Realism Media Involvement Role Identification Mental Health/ Perceived Realism 1.9 ± 1.0 (0 - 3.2) 2.9 ± .8 (1.4 - 4.0) 1.4 ± .8 (0 - 2.8) 2.1 ± 1.4 (0 - 4.0) Note. 2-tailed. *p < .05. ** p < .01 Media Involvement Role ID Mental Health/ Perceived Realism .29* .06 .17 - .22 .21 - - .09 - - - TV and Mental Health 47 Acute effects of TV viewing on mental health attitudes. In order to determine the acute effects of the episode just viewed on MHrelated attitudes, a series of mixed model ANOVAs were conducted on the four CAMI subscale scores obtained in both Session I and Session II. Episode was the between-group factor and had three levels (i.e., CTRL, MH- and MH+) while Session was the within subjects factor with two levels. Due to the small sample size and the exploratory nature of this research, a significance level of .10 was used. No significant main effects or interactions were found (see Table 22). Examination of the group means and standard deviations for each subscale at both points in time suggested that attitudes were generally very positive (see Table 23). Accordingly, the null findings may, in part, reflect the restricted of range observed CAMI scores. As previously indicated, possible scores for the CAMI sub-scales range from 10 to 50. Average scores for the four sub-scales at both points of time, and for all groups were very positive. Moreover, individual scores across the subscales and sessions ranged from 2850. TV and Mental Health 48 Table 22 ANOVA Tables for Four CAMI sub-scales Authoritarianism Session Sphericity Assumed Type III Sum of Squares .84 1 .84 .13 .72 Session * Episode Sphericity Assumed 3.00 2 1.50 .23 .79 Error(Session) Sphericity Assumed 288.66 45 6.42 21.58 2 10.8 .30 .75 1636.91 45 36.38 Source Episode Error (Episode) Df Mean Square F Sig. Benevolence Source Session Sphericity Assumed Type III Sum of Squares 1.26 Session * Episode Sphericity Assumed 9.08 2 4.54 Error (Session) Sphericity Assumed 199.16 45 4.43 37.33 2 18.7 1431.12 45 31.80 Episode Error (Episode) Df 1 Mean Square 1.26 F .29 Sig. .60 1.03 .37 .59 .56 Social Restrictiveness Source Session Sphericity Assumed Type III Sum of Squares 2.34 Session * Episode Sphericity Assumed 2.31 2 1.16 Error(Session) Sphericity Assumed 224.84 45 5.00 1.69 2 .84 1425.22 45 31.67 Df 1 Mean Square .17 F .03 Sig. .86 2.10 .13 .33 .72 Episode Error (Episode) Df 1 Mean Square 2.34 F .47 Sig. .50 .23 .79 .03 .97 Community Mental Health Ideologies Source Session Sphericity Assumed Type III Sum of Squares .17 Session * Episode Sphericity Assumed 22.65 2 11.32 Error(Session) Sphericity Assumed 242.19 45 5.38 39.81 2 19.91 2693.81 45 59.86 Episode Error (Episode) TV and Mental Health 49 Table 23 CAMI Attitude Sub-scale Descriptives for Session I and Session II Mean Auth Ben Soc Res CMHI Session I Std. Deviation Range Mean Session II Std. Deviation Range CTRL 41.9 5.14 34 - 50 41.3 5.18 32 - 50 MH- 41.7 5.09 31 - 47 41.8 3.79 36 - 49 MH+ 40.6 3.67 33 - 48 40.7 4.61 33 - 49 CTRL 44 4.75 32 - 50 43.7 4.01 36 - 50 MH- 43.8 4.40 36 - 50 42.9 4.53 34 - 49 MH+ 42.1 3.89 35 - 50 42.6 3.88 35 - 48 41.4 4.37 33 - 49 41.9 4.33 34 - 49 MH- 41.7 4.91 32 - 48 42.3 4.31 36 - 49 MH+ 41.8 3.87 31 - 46 41.6 3.81 35 - 49 CTRL 39.9 5.81 29 - 49 39.9 6.20 30 - 50 MH- 40.3 6.15 30 - 49 39.3 6.10 28 - 48 MH+ 40.1 4.93 28 - 49 41.9 4.91 32 - 49 CTRL Note. n/grp = 16 It is interesting to note that a slight trend was evident in the interaction term of the ANOVA conducted on the CMHI scores. Since there were no initial group differences in the CMHI attitude sub-scale (i.e. Session I: F(2,45)=1.58, p .95), the % change in the CMHI scores across the two sessions was calculated for all participants (session2/session1*100), and reanalyzed using a one-way between subjects ANOVA. While the main effect was not significant (F(2,45) = 2.10, p = .14), the results again were suggestive of a trend. As displayed in Figure 3, the results indicate that the attitudes of the control group did not change across the two sessions. However, the MH- group attitudes became, on average, slightly more negative after viewing the negatively-toned episode, while attitudes became, on average, slightly more positive in the MH+ group after watching the positively-toned episode. TV and Mental Health 50 Episode Watched Figure 3. Percentage change in attitudes across Session I and Session II for CAMI CMHI sub-scale scores as a function of episode watched. Percent change was calculated as CMHI T2/CMHI T1*100. It should be noted that exploratory analyses designed to evaluate the extent to which psychological involvement with the viewed episodes mediated the changes in attitudes had been planned. However, given the null findings, the observed restriction in range of attitude scores, and the limited sample size, it was not feasible to conduct these analyses. Accordingly, these relationships were not examined. Discussion This study was very complex and addressed two overarching questions in a sample of university students. The first question concerned the relationship TV and Mental Health 51 between various aspects of TV viewing habits and experiences and attitudes about mental health/disorders. The second question concerned the acute effects of watching a single TV episode on MH attitudes. Specifically, the study evaluated the extent to which episodes that differed in terms of content (i.e., mental health vs. not mental health) and affective tone of MH storylines (i.e., positive vs. negative) would differentially influence attitudes. To address these questions, however, it was first necessary to develop a measure that would permit a more comprehensive assessment of TV viewing habits and experiences. Most of the research conducted to date has only considered a few quantitative measures of TV viewing habits. By far, the most commonly used measure is total hours/week. However, recent research by Bahk (2001) suggested that psychological aspects of people’s TV viewing experiences could be an important determinant of attitudes. Using Bahk’s (2001) model of psychological involvement, two versions of the TUBE were developed. The TUBE I was designed to measure psychological aspects of watching a serial TV show. For purposes of this study, serial dramas were the focus of this measure. In contrast, the TUBE II assessed psychological involvement experienced while watching a discrete episode. It should be noted that the TUBE I also includes items that assess quantitative aspects of TV viewing habits. The present study provided preliminary evidence that it is possible to measure psychological involvement in relation to TV viewing. Psychometric evaluation of both forms of the TUBE measures indicated that the measures were tapping four inter-related aspects of psychological involvement. Importantly, these sub-scales were congruent with Bahk’s model: media TV and Mental Health 52 involvement, role identification, perceived realism, and perceived realism of mental health-related content. As not all episodes viewed included MH-related content, PR/MH was analyzed separately from the other three components. It is a possibility that the difference between PR and PR/MH is only related to the breadth of the focus. That is, PR may be related to overall viewing while PR/MH may be limited to content-specific elements. While the present data suggest that these facets of psychological involvement are inter-related, it is not clear whether this is congruent with Bahk’s theory. That is, he has not addressed this issue in his research. Further research is needed to evaluate the nature of the interrelationships between these different aspects of psychological involvement. In addition, it will be important to evaluate further the psychometric properties of both forms of the TUBE. For example, while the results of the PCAs suggest that the various components are reliable, other types of reliability (e.g., test-retest) were not evaluated. In addition, the procedures used to develop these tests and the results of the PCAs provide preliminary evidence for content validity (Cohen & Swerdlik, 2005), however, further tests are recommended which will contribute to the overall evidence of the validity of the measure. With regards to general TV viewing habits, the present sample of participants reported watching an average of 9.3 ± 4.7 hours/week. However, the amount of time varied tremendously across participants with some reporting watching very little (e.g., 0 hrs), and some a lot (e.g., 40 hrs). In general, dramas and comedies were reported by our sample as being watched most frequently. This is congruent with the findings that these are nationally ranked as the two favorite genres. Interestingly, the average hours/week was substantially lower for TV and Mental Health 53 dramas (by 48.8%) than the national averages while they were similar for the category of comedy (Statistics Canada, 2006). It is likely that this difference is due to the demographic characteristics of the present sample. That is, the sample was relatively young, and all participants (except one) were upper level university students. Moreover, this study was conducted in the middle of the second semester – a time when students typically are preparing for mid-term exams and other assignments, possibly reducing the amount of hours dedicated to TV entertainment. Results from the TUBE I suggested that there were individual differences with regards to how involved people were in their favorite drama TV shows. These aspects of psychological involvement were not correlated with the quantitative amounts of TV that participants were watching. More data may help determine the nature of these effects on attitudes and determine if both quantitative and psychological aspects are important to consider in relation to attitudes. Future research should consider the conjoint influence of these two variables. This study only focused only on the genre of drama, it may also be beneficial to also consider these variables in relation to other genres of TV viewing. This is data that we have collected through this study and will be analyzing at a later date. Attitudes of the participants were demonstrated to be very positive. The demographics and education level of our sample (e.g., their level of knowledge of Mental health disorders and stigma) may have contributed to these strong positive attitudes creating a restriction in range, limiting the possibility of identifying any possible changes in attitudes. The results also suggested that the TV and Mental Health 54 more direct, and as such more personal, the experience, the more positive the attitudes towards mental health. This replicated some of the previous research which examined ones level of experience with mental illness and attitudes towards mental health. Future research may take into consideration the possible differences based on inaccurate or accurate portrayals of mental illness within TV. In terms of the relationships between quantitative measures of TV viewing habits and attitudes, no significant relationships were found. This is contrary to previous research however, the reduced quantities of viewing times (both overall and specific to genre) and the restriction in range in attitudes from our student sample may have limited results in this area. When the relationships between psychological aspects of TV viewing habits and attitudes were examined, several relationships were found between the attitude factors and the psychological components. Specifically, Perceived Realism was positively correlated with Benevolence, and Media Involvement was positively correlated with both Benevolence and Social Restrictiveness. Although not all the components were significantly correlated, results suggest that psychological aspects to TV viewing habits are important to consider when examining influences on mental health attitudes, specifically, that greater perceived realism and greater involvement in TV may be related to more empathetic and supportive attitudes towards the mentally ill. The preliminary nature of these findings indicates that more research is needed, however, use of a more diverse sample would be beneficial (i.e., one that not limited to psychology educated students with strong familiarity with mental illness) which TV and Mental Health 55 may lead to more variability in attitudes (i.e., those not restricted to the positive ranges of attitudes). With regards to the second research question, the present study attempted to determine whether viewing a single episode of a TV show could have a direct impact on a person’s attitudes. In particular, the impact of three episodes from the same season of the same series was evaluated. The episodes differed with two of the three containing mental health related content and the third containing no mental health content. Of the two mental health episodes, they differed in terms of the affective tone of the mental health related storyline. All the episodes were found to be similar in the interest level, emotional intensity and perceived realism aspects to the episodes. Although no significant findings were obtained, there were some suggestions that an effect of a specific TV experience could influence one’s attitudes. First, in the pilot study participants reported that based on the viewed episodes, their attitudes and beliefs were affected. Through review of the comments made, it was suggested that attitudes of those viewing the positively-toned mental health episode became more positive. Secondly, within the full study, a trend was seen in the CMHI scores. Results suggested that attitudes of the control group did not change across the two sessions. However, the MH- group attitudes became, on average, slightly more negative after viewing the negatively-toned episode, while attitudes became, on average, slightly more positive in the MH+ group after watching the positively-toned episode. Although not significant, these results suggest that this line of research is worth pursuing further. Again, the demographics of the sample, high level of direct contact with mental illness, observed restriction of TV and Mental Health 56 range in the attitudes of the sample both previous to and after watching the episode, may have affected our results. In addition, in utilizing a popular TV show, some had seen it previously, possibly causing them, perhaps, to focus less on the content (having previously seen the episode) and therefore possibly decreasing the likelihood of any effects. The measures used to assess attitudes (the CAMI) were self-report measures and very transparent in their questions. This may have encouraged participants to respond in a socially desirable way. Unfortunately, this response tendency was not measured in the present study. In this way, indirect measures of attitudes may be useful and although this was included later in the study, data was limited to a smaller sample and was not able to be utilized. Another suggestion is if these measures are used again, a measure of social desirability should be included. It is also possible that a reliable or robust effect of a single episode on attitudes was not observed because the impact of the episode may vary as a function of how psychologically involved the participants were, while watching the episode. Originally, the relationship between the various facets of psychological involvement with the viewed episodes, and changes in attitudes was originally intended to be explored, based on the null findings, restriction in range of attitude scores, and the limited sample size, these relationships were not examined. Finally, it is important to acknowledge some of the limitations that were associated with this study. As previously indicated, restriction of range was a problem on several of the measures, and in particular in the measures of attitudes. As described above, this may have limited ability to obtain statistically reliable effects. As well, the measure of attitude used was self-report and, TV and Mental Health 57 consequently, transparent possibly leading to answers that were prone to effects of social desirability. These problems may, in part, be attributable to the small and homogeneous sample. That is, there were only 48 participants in total. Moreover, they were all students, the majority were Caucasian, were relatively young, in upper level university classes and with one exception, they were all taking at least one university-level psychology course. This increases the likelihood that the participants have more accurate information on mental health and mental illness, based on courses that they have taken. They may also be more sensitive to the issue of stigma and hold more positive attitudes towards mental health. These limitations may have limited the power to detect changes in our analyses. Further, the nature of the sample limits the generalizability of results. As such, it is important that future research use a broader, wider range of participants who may demonstrate more variability in the variables being examined. Conclusion Understanding the relationship between attitudes about mental health/disorders and TV viewing habits and experiences is important when considering the influential nature of TV. Research to date regarding TV’s role as a determinant of attitudes has largely relied upon gross quantitative measures of TV viewing habits (e.g., total hours of TV watched/week). The research has also relied almost exclusively upon correlational methods. The present study served to extend this line of research in several ways. First, multiple quantitative indices of TV viewing habits were used. Specifically, hours of total TV watched as well as TV and Mental Health 58 hours watched as a function of genre, from which we utilized all the information that pertained specifically to drama. Secondly, psychological aspects of TV viewing experiences were assessed and found to be related to certain types of mental health-related attitudes. Thirdly, this study used an experimental design in order to evaluate more directly the influence of TV on attitudes, through examination of the influences of content and affective tone of the storylines. Taken together, the results of the present study provide preliminary evidence of the importance of evaluating both quantitative and psychological aspects of TV viewing habits. While no reliable evidence of a direct effect of TV on attitudes was obtained, the research was hindered through the use of a sample that one analyzed, was found to be very similar with regards to educational background, contact with mental health/disorders, attitudes towards mental health/disorders, therefore detecting effects was severely limited. In addition, the selection of measures may have hampered information gathering with questions being fairly transparent in their wordings. Overall, a broader sample and more indirect measures of attitudes may further this experimental component of the research. By examining the relationship between psychological aspects of TV viewing experiences and mental health-related attitudes, more in-depth exploration into the concept of specific MH-related storylines and the multiple affective tones that can be extracted. Further focus on aspects specific to TV viewing, such as the importance of genre as a limiter within individual TV viewing habits and styles can be explored. From a design stand point, much of this research has been correlational, with only very few studies conducting experimental manipulations to explore the TV and Mental Health 59 nature of some of these variables. The present findings indicate the necessity to further examine the aspects to TV viewing, both quantitative and psychological, their potential effects on MH-related attitudes. Understanding the nature of these relationships may impact not just our understanding of the formation of attitudes but allow us a better understanding of reasons for seeking or avoiding treatment, help seeking behaviors and possible prevention methods. TV and Mental Health 60 References Addison, S.J., & Thorpe, S.J. (2004). Factors involved in the formation of attitudes towards those who are mentally ill. Social Psychiatry Psychiatric Epidemiology, 39, 228-234. Angermeyer, M.C., & Matschinger, H., (1996). The effect of personal experience on the attitude towards individuals suffering from mental disorders. Social Psychiatry Psychiatric Epidemiology, 31, 321-326. Bahk, C.M. (2001). Drench effects of media portrayal of fatal virus disease on heath locus of control beliefs. Health Communications, 13, 187-204. Canadian Mental Health Association. (2008). Fast Facts: Mental Health/Mental Illness. Retrieved from http://www.cmha.ca/bins/content_page.asp?cid=620-23-43 Cohen, R. J., & Swerdlik, M.E. (2005). Psychological testing and assessment: An introduction to tests and measurements, Sixth Edition. New York: McGraw Hill. Corrigan, P.W., Green, A., Lundin, R., Kubiak, M. A., & Penn, D.L. (2001). Familiarity with and social distance from people who have serious mental illness. Psychiatric Services, 52, 953-958. Diefenbach, D.L. (1997). The portrayal of mental illness in prime time television. Journal of Community Psychology, 25, 289-302. Edney, D. R. (2004). Mass media and mental illness: A literature review. Ottawa, Canada: Canadian Mental Health Association. Retrieved on January 2, 2006 from: http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp TV and Mental Health 61 Geocities (2000). ER the website episode guide. Retreived from http://www.geocities.com/erthewebsite/er_episode_guide.htm Granello, D.H., & Pauley, P.S. (2000). Television viewing habits and their relationship to tolerance toward people with mental illness. Journal of Mental Health Counseling, 22, 162-175. Health Canada (2002). A report on mental illneses in Canada. Retreived from http://www.phac-aspc.gc.ca/publicat/miic-mmac/pdf/men_ill_e.pdf Holmes, E., Corrigan, P., Williams, P., Canar, J. & Kubiak, M. (1999). Changing attitudes about schizophrenia. Schizophrenia Bulletin, 25, 447-456. IMDB Movie Database (2008). Awards for ‘ER’. Retreived from http://www.imdb.com/title/tt0108757/awards http://www.rand.org/health Mansfield, A.K., Addis, M.E., & Courtenay, W. (2005). Measurement of men’s help seeking: Development and evaluation of the barriers to help seeking Scale. Psychology of Men & Masculinity, 6, 95-108. McKenzie, C.S., Knox, V.J., Gekoski, W.L., & Macaulay, H. L. (2005). The adaption and extension of the attitudes towards seeking professional psychological help scale. Journal of Applied Social Psychology, 34, 24102435. Nunnally, J. (1961). The popular conceptions of mental health: Their development and change. 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American Journal of Psychology, 17, 521-528. Zwick, W.R., & Velicer, W.F. (1986). Comparison of five rules for determining the number of components to retain. Psychological Bulletin, 99, 432-442. TV and Mental Health 63 Appendix A ER Episode Descriptions Episode 6 Description: OSCAR WINNER SALLY FIELD ('NORMA RAE') GUEST-STARS AS ABBY'S MOTHER -- An anguished Abby (Maura Tierney) flinches when she is unexpectedly visited by her unpredictable mother (Oscar-winning guest star Sally Field, "Norma Rae") while Dr. Benton (Eriq La Salle) is shocked to discover details about a severely wounded gunshot victim. Meanwhile, Drs. Greene (Anthony Edwards) and Corday (Alex Kingston) pledge to each other that they will escape the ER for a weekend getaway but complications ensue when she must perform surgery on a middle-aged surfer (guest star Alan Dale) with a bad back. Dr. Kovac (Goran Visnjic) suspects that a young teenaged patient (guest star Susan Enriquez) -- who proves to be pregnant -- might have been assaulted by her father (guest star Timothy Paul Perez). Dr. Chen (Ming-Na) finally confronts the unsuspecting father of her baby. Episode 10 Description: JAMES BELUSHI ('RETURN TO ME') GUEST-STARS ON NEW YEAR'S EVE -- New Year's Eve falls as Dr. Greene (Anthony Edwards) submits to dangerous, experimental brain surgery in New York with a hopeful Dr. Corday (Alex Kingston) by his side while a guilt-ridden father (guest star James Belushi, "Return to Me") who is severely injured in a car wreck is only concerned with the safety of his teenaged son (guest star Jared Padalecki) who is also hurt. However, the dad's condition deteriorates as the irascible Dr. Romano (Paul TV and Mental Health 64 McCrane) is called on to begin desperate heart surgery and Greene's radical procedure soon develops complications. Episode 21 Description: DOES ABBY SEE A RAY OF HOPE FOR HER UNBALANCED MOTHER? SALLY FIELD GUEST-STARS -- A distressed Abby (Maura Tierney) sees a ray of hope in the care of her mentally unbalanced mother (Oscar-winning guest star Sally Field) when she receives some sage advice from the older woman in a rare moment of clarity while Dr. Benton's (Eriq La Salle) old girlfriend Carla (guest star Lisa Nicole Carson, "Ally McBeal") squares off against his new love Cleo (Michael Michele). Elsewhere: Dr. Greene's (Anthony Edwards) suspicions are aroused when he treats a rebellious 7-year-old boy (guest star Emmett Shoemaker) who bears signs of beatings; Dr. Carter's (Noah Wyle) plans to apply for chief resident are brushed aside by Dr. Weaver (Laura Innes) while he watches fellow candidate Dr. Chen (Ming-Na) take her best shot at the position; Weaver suffers pangs of remorse when she meets the new woman in Dr. Legaspi's (Elizabeth Mitchell) life and is confronted by a helpless, mentally deficient young woman (guest star Julie Osburn) whose only family member lies in critical condition; and the ER gang enjoys a spirited game of softball. TV and Mental Health Appendix B Pilot Study Measures – Demographics Please provide the following demographic Information. 1. Age 2. Sex years ❏ Male ❏ 3. Education Female ❏ First year undergraduate ❏ Second year undergraduate ❏ Third year undergraduate ❏ Fourth (or more) year undergraduate ❏ Graduate Studies Please specify highest level completed: 4. Marital Status ❏ Single ❏ Married or common-law ❏ Separated or divorced ❏ Other 5. Ethnicity ❏ Caucasian ❏ Aboriginal ❏ Asian ❏ Other Please specify: 65 TV and Mental Health 66 Appendix B – Pilot Study Measures – Questionnaire Please answer the following questions as they pertain to the episode of ER that you have just finished watching. Please note that there are no right or wrong answers to any of the questions about the TV episode. We are interested in your personal reactions, experiences and opinions -- whatever they may be. 1. Briefly describe all of the major storylines: TV and Mental Health Not at all 2. How interesting was this episode to you? 0 1 2 Very 3 4 Comments: 3. How intensely were you concentrating while watching this episode? Not at all 01 2 3 Very 4 Not at all 0 1 2 3 Not at all 0 1 2 3 Very 4 Not at all 0 1 2 3 Very 4 Comments: 4. How realistic was this episode? Very 4 Comments: 5. How dramatic was this episode? Comments: 6. How emotional was this episode? 67 TV and Mental Health 68 Comments: 7. How interesting were the characters within 0 this episode? Not at all 1 2 3 Very 4 3 Very 4 Comments: 8. Which character did you identify with most? Comments: Not at all 9. How realistic were the scenes that dealt with 0 1 2 mental health issues? Comments: Not at all 10. To what extent were your attitudes or beliefs 0 1 2 about people with a mental health disorder affected by watching this episode? 3 Very much 4 TV and Mental Health 69 Please describe how your attitudes or beliefs were affected: Not at all 11. To what extent were your attitudes or beliefs 0 1 2 about getting help or treatment for a mental health problem affected by watching this episode? Very much 3 4 Please describe how your attitudes or beliefs were affected: Not Very 12. After watching this episode, how inclined are 0 1 2 you to watch the next episode in this series? 13. After watching this episode, how inclined are you to watch this series on a regular basis? 14. Have you watched this series before? 14a. If yes, how often? Not Very 0 1 2 Yes Rarely 0 1  2 3 Very 4 3 Very 4 No  3 Frequently 4 TV and Mental Health 14b. Have you ever seen this episode before? Yes  No 70  15. In the space below, please tell us any other thoughts, reactions that you had while watching the episode or afterwards. Thank-you for participating in this study! If you have any questions or comments, please let Jodi know. Not sure  TV and Mental Health 71 Appendix C - Consent Forms – Pilot Irving K. Barber School of Arts and Sciences Psychology and Computer Science 3333 University Way Kelowna, BC Canada V1V 1V7 Consent Form Perceptions of a medical drama TV series: A pilot study Principal Investigator: Co-investigators: Carolyn Szostak, Department of Psychology, UBCO, 807-8736 Jodi Webster, IK Barber School, student researcher, UBCO Purpose: People’s attitudes and beliefs about physical and mental health disorders are informed by many different sources of information and/or types of experiences. Research suggests that the media is a major source of influence for a majority of people. Moreover, television (TV) and movies have been found to be especially influential. You have been asked to participate in a pilot (i.e., preliminary) study that is investigating the perceptions of, and reactions to a number of episodes of a TV medical drama. This study is to ensure that the selected episodes are similar in some regards (e.g., interest, intensity, etc.) and different in others (e.g., major storylines). Ultimately, some of these episodes will be the basis of a full-scale study that will look at the acute effects of watching medical dramas on people’s attitudes and beliefs about physical and mental disorders and their treatment. The pilot and full-scale study are the basis of Jodi Webster's undergraduate Honours Thesis. It is also anticipated that the results of these two studies will be submitted for publication in a peer-reviewed psychology journal. Study Procedures: As a volunteer participant in this study you will be asked to watch one episode of a medical drama and then complete two questionnaires. One questionnaire includes a series of questions (close- and open-ended) designed to assess your perceptions of, and reactions to the major storylines and content of the episode. The second questionnaire has questions about your demographics. It will take approximately 60 minutes to watch the episode and complete the questionnaires. Please note that there are no right or wrong answers to any of the questions about the TV episode. We are interested in your personal reactions, beliefs and experience -- whatever they may be. While we ask that you try to answer all questions, if there are any questions that you do not feel comfortable answering you are free to leave those questions blank. If you have any questions during the session, please ask the researcher. You will not receive any direct financial compensation for your participation. If you are registered in a Psychology course that provides students with bonus marks for participating in research projects, and you volunteered through SONA, you will receive 1 bonus mark in the associated class. You should know that none of the researchers conducting this study have any conflict of interest. Confidentiality: Your participation and all information you provide will be kept confidential. All completed questionnaires will be kept in a secure location that is accessible only to the researchers involved in this study. Information from the completed questionnaires will be TV and Mental Health 72 transferred to password-protected computer files for the purpose of data analysis. Again, only individuals directly involved in this study will have access to these computer files. The information that you provide will not be anonymous. That is, the researchers will know who provided what information. However, we will not identify you, or connect your name with your responses, to anyone not directly involved with this project. Moreover, in all publications and presentations of the research findings, no information that would allow someone to identify specific participants will be released. In addition, your individual responses will not be released. In order to ensure your confidentiality, your testing package has been assigned a research number that is located on this Consent Form and, as well, on the first page of the questionnaire package. Upon completion of the package, the number will be affixed to all other pages. This number will be used to match your name with your responses. Consent Forms will be stored separately from completed questionnaires. Access to these files will be restricted to the researchers directly involved in this study. Risks and Benefits of Participating in this Study: There are minimal risks associated with participating in this project. All episodes being used in this study have been aired on public television during primetime. Given network requirements, it is unlikely that these episodes contain harmful content. However, it is important that you are aware that the episodes include explicit scenes about physical and mental health problems and their treatment. Some individuals may find these scenes mildly distressing for a brief time. If you are concerned about viewing this type of content, please know that you do not have to participate in this study. You may leave now or at any time during the session, without penalty. While there are no direct benefits associated with your participation, it is possible that your awareness of issues related to mental health attitudes and media usage may be enhanced, leading to indirect health-related benefits. Contact for information about the study: If you have any further questions about the study you may contact Carolyn Szostak at 807-8736 or by email at Carolyn.Szostak@ubc.ca. Alternatively, you may contact Jodi Webster by email at jcwebst@interchange.ubc.ca. Contact for the concerns about the rights of research participants: If you have any questions or concerns about your treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail to RSIL@ors.ubc.ca. Consent: Your participation in this study is strictly voluntary and you are free to withdraw from participation at any time without penalty. Your signature below indicates that you have read and understood the above information, and that you have received a copy of this consent form for your own records. Your signature below indicates that you consent to participate in this study. Participant Signature Date Printed Name of Participant Investigator Signature Printed Name of Investigator Date TV and Mental Health 73 Appendix C – Consent Form – Full Study Irving K. Barber School of Arts and Sciences Psychology and Computer Science 3333 University Way Kelowna, BC Canada V1V 1V7 Consent Form Television and Mental Health Principal Investigator: Carolyn Szostak, Department of Psychology, UBCO, 8078736 Co-investigator: Jodi Webster, IK Barber School, student researcher, UBCO Purpose: People’s attitudes and beliefs about mental health disorders are informed by many different sources of information and/or types of experiences. Research suggests that the media is a major source of influence for a majority of people. Television (TV) has been found to be especially influential. This study is designed to enhance our understanding of the relationship that exists between TV viewing habits and preferences, especially with regards to TV dramas, and beliefs about mental health and mental health disorders. This study is the basis of Jodi Webster's undergraduate Honours Thesis. It is anticipated that the results of this study will be submitted for publication in a peer-reviewed psychology journal. Study Procedures: As a volunteer participant in this study you will be asked to participate in two sessions, separated by approximately one week. In the 1st session, you will complete a series of self-report questionnaires. The questions will address your beliefs about mental health issues, and your TV viewing habits and preferences. There will also be some questions about your demographics. It will take approximately 50 minutes to complete the first session. During the 2nd session, you will be asked to watch one of three episodes of a TV medical drama and then complete a set of questionnaires. The specific episode that you watch will be randomly determined. The questionnaire packet will include questions designed to assess your perceptions of and responses to the TV episode, and also mental health issues. It will take approximately 70 minutes to watch the episode and complete the questionnaires. Please note that there are no right or wrong answers to any of the questions. We are interested in your personal reactions, beliefs and experiences -- whatever they may be. While we ask that you try to answer all questions, if there are any questions that you do not feel comfortable answering you are free to leave those questions blank. If you have any questions during the session, please ask the researcher. TV and Mental Health 74 If you participated in the study titled “Perceptions of a medical drama TV series: A pilot study”, conducted by Carolyn Szostak and Jodi Webster, please be aware that you are not eligible to participate in the present study. You will not receive any direct financial compensation for your participation. If you are registered in a Psychology course that provides students with bonus marks for participating in research projects, and you volunteered through SONA, once you have completed both sessions, you will receive 2 bonus marks in the associated class. You should know that none of the researchers conducting this study have any conflict of interest. Confidentiality: Your participation and all information you provide will be kept confidential. All completed questionnaires will be kept in a secure location that is accessible only to the researchers involved in this study. Information from the completed questionnaires will be transferred to password-protected computer files for the purpose of data analysis. Again, only individuals directly involved in this study will have access to these computer files. The information that you provide will not be anonymous. That is, the researchers will know who provided what information. However, we will not identify you, or connect your name with your responses, to anyone not directly involved with this project. Moreover, in all publications and presentations of the research findings, no information that would allow someone to identify specific participants will be released. In addition, your individual responses will not be released. In order to ensure your confidentiality, your testing package has been assigned a research number that is located on this Consent Form and, as well, on the first page of the questionnaire package. Upon completion of the package, the number will be affixed to all other pages. This number will be used to match your name with your responses. It will also be indicated on the questionnaire packet that you complete during the 2nd session. Consent Forms will be stored separately from completed questionnaires. Access to these files will be restricted to the researchers directly involved in this study. Risks and Benefits of Participating in this Study: There are minimal risks associated with participating in this project. All episodes being used in this study have been aired on public television during primetime. Given network requirements, it is unlikely that these episodes contain harmful content. However, it is important that you are aware that the episodes include explicit scenes about physical and mental health problems and their treatment. Some individuals may find these scenes mildly distressing for a brief time. If you are concerned about viewing this type of content, please know that you do not have to participate in this study. You may leave now or at any time during either session, without penalty. While there are no direct benefits associated with your participation, it is possible that your awareness of issues related to mental health attitudes and media usage may be enhanced, leading to indirect health-related benefits. TV and Mental Health 75 Contact for information about the study: If you have any further questions about the study you may contact Carolyn Szostak at 807-8736 or by email at Carolyn.Szostak@ubc.ca. Alternatively, you may contact Jodi Webster by email at jcwebst@interchange.ubc.ca. Contact for the concerns about the rights of research participants: If you have any questions or concerns about your treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail to RSIL@ors.ubc.ca. Consent: Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time without penalty. Your signature below indicates that you have received a copy of this consent form for your own records. Your signature indicates that you consent to participate in this study. Participant Signature Printed Name of Participant Date TV and Mental Health 76 Appendix D- Full Study Measures- Description of other measures used To measure participant’s knowledge and beliefs about mental illness we used the Nunnally Knowledge Questionnaire (NKQ; Nunnally, 1961). It consists of 40 statements that participants indicate their level of agreement, using a 7point Likert-type scale (i.e., 1 = Completely Disagree, 7 = Completely Agree). The items comprise ten factors: Look and act differently, Willpower, Sex distinction, Avoidance of morbid thoughts, Guidance and support, Hopelessness, Immediate external environment versus personality dynamics, Nonseriousness, Age function and Organic causes. Despite being developed in 1961, and containing language not currently used, this measure has been used in recent research because it provides a comprehensive assessment of knowledge of mental illness (Addison & Thorpe, 2004). Moreover, it remains a reliable and valid measure of such knowledge. Use of the NKQ will also permit the comparison of the present results with other recent research. 18 items were reverse scored. Once this was completed, subscales were scored by summing the individual items. Higher subscale scores indicates more accurate knowledge about mental health. Two subscales of the Rand Medical Outcome Survey were used to assess the current mental health status of the participant. The Mental Health Inventory (MHI; http://www.rand.org/health) contained twenty-two items appropriate to adults of a broad range of ages. Together, these items form the following two sub-scales: Mental Health Index II (17 items) and Psychological Well-being II (10 items). Response options varied across questions. Scoring involves reverse scoring of 12 items. In addition, scores are converted to a 100 point scale, such TV and Mental Health 77 that lower numbers indicate greater psychological well being. To assess any change in the psychological wellbeing of the participants across the two sessions, the Current Health Status questionnaire (CHS) was developed by the researchers. It consists of 2 questions designed to assess current mental health status and whether there has been a change since the first session. For both questions, participants are asked to indicate their response using a 6-point Likert-type scale. Specific response options vary across the two questions. A story-telling measure, the Indirect Measure of Attitudes (IMA), developed by the researchers, was designed to provide an indirect measure of participants’ attitudes about mental health/disorders. A revision to the original study protocol requested the use of the Indirect Measure of Attitudes. This measure was used on participant 10 – 49.The IMA was placed last in both versions of questionnaire packets. Participants were asked to write a short story about two specified characters who had been involved in one of the main storylines of the episode just viewed. Various emotional, cognitive, and structural components (e.g., differential use of positive and negative emotion words, total number of words, number of social words, pronoun use, etc.) of the generated stories were analyzed using linguistic software (Pennebaker, et al., 2007). Two versions of the IMA (IMA-I and IMA-II) were used; the two forms are necessary because of the fact that the main characters involved in the two mental health- related episodes are not featured in the control episode. TV and Mental Health 78 Appendix E - Full Study Measures – Community Attitudes towards the Mentally Ill The following is a survey of attitudes towards mental health community services. These questions are intended to assess your personal opinions and beliefs. As such, there are no right or wrong answers. What is important is that you answer them as openly and as honestly as you can. If you strongly agree with the statements presented you should circle a one. If you strongly disagree with the statement presented, you should circle 5. You can also circle any number in between to indicate the strength of your opinion of the statement. Strongly Agree Strongly Disagree 1. As soon as a person shows signs of mental disturbances, s/he should be hospitalized. 1 2 3 4 5 2. More tax money should be spent on the care and treatment of the mentally ill. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 7. The mentally ill are far less dangerous than most people suppose. 1 2 3 4 5 8. Locating mental health facilities in a residential area downgrades the neighborhood. 1 2 3 4 5 9. There is something about the mentally ill that makes it easy to tell them from normal people. 1 2 3 4 5 10. The mentally ill have for too long been the subject of ridicule. 1 2 3 4 5 1 2 3 4 5 12. As far as possible mental health services should be provided through community based facilities. 1 2 3 4 5 13. Less emphasis should be placed on protecting the public from the mentally ill. 1 2 3 4 5 14. Increased spending on mental health services is a waste of tax dollars. 1 2 3 4 5 3. The mentally ill should not be isolated from the rest of the community. 4. The best therapy for many mental patients is to be part of a normal community 5. Mental illness is an illness like any other. 6. The mentally ill are a burden on society. 11. A woman would be foolish to marry a man who has suffered from mental illness, even though he seems fully recovered. TV and Mental Health Strongly Agree 15. No one has the right to exclude the mentally ill from their neighborhood. 79 Strongly Disagree 1 2 3 4 5 1 2 3 4 5 17. Mental patients need the same kind of control and discipline as a young child. 1 2 3 4 5 18. We need to adopt a far more tolerant attitude toward the mentally ill in society. 1 2 3 4 5 19. I would not want to live next door to someone who has been mentally ill. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 23. Mental patients should be encouraged to assume the responsibilities of normal life. 1 2 3 4 5 24. Local residents have good reason to resist the location of mental health services in their neighborhood. 1 2 3 4 5 25. The best way to handle the mentally ill is to keep them behind locked doors. 1 2 3 4 5 26. Our mental hospitals seem more like prisons than places where the mentally ill can be cared for. 1 2 3 4 5 27. Anyone with a history of mental problems should be excluded from taking public office. 1 2 3 4 5 28. Locating mental health services in residential neighborhoods does not endanger local residents. 1 2 3 4 5 16. Having mental patients living within residential neighborhoods might be good therapy but the risks to residents are too great. 20. Residents should accept the location of mental health facilities in their neighborhood to serve the needs of the local community. 21. The mentally ill should not be treated as outcasts of society. 22. There are sufficient existing services for the mentally ill. TV and Mental Health Strongly Agree 29. Mental hospitals are an out-dated means of treating the mentally ill. 80 Strongly Disagree 1 2 3 4 5 1 2 3 4 5 31. The mentally ill should not be denied their individual rights. 1 2 3 4 5 32. Mental health facilities should be kept out of residential neighborhoods. 1 2 3 4 5 33. One of the main causes of mental illness is a lack of selfdiscipline and will power. 1 2 3 4 5 34. We have a responsibility to provide the best possible care for the mentally ill. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 39. Most women who were once patients in a mental hospital can be trusted as babysitters. 1 2 3 4 5 40. It is frightening to think of people with mental problems living in residential neighborhoods. 1 2 3 4 5 30. The mentally ill don’t deserve our sympathy. 35. The mentally ill should not be given any responsibilities. 36. Residents have nothing to fear from people coming into their neighborhood to obtain mental health services. 37. Virtually anyone can become mentally ill. 38. It is best to avoid anyone who has mental problems. TV and Mental Health 81 Appendix E - Full Study Measures – Level of Familiarity Questionnaire Please read each of the following statements carefully. After you have read all of the statements below, place a check by EVERY statement that represents your experience with persons with a severe mental illness. ____ I have watched a movie or television show in which a character depicted a person with mental illness. ____ My job involves providing services/treatment for persons with a severe mental illness. ____ I have observed, in passing, a person I believe may have had a severe mental illness. ____ I have observed persons with a severe mental illness on a frequent basis. ____ I have a severe mental illness. ____ I have worked with a person who had a severe mental illness at my place of employment. ____ I have never observed a person that I was aware had a severe mental illness. ____ A friend of the family has a severe mental illness. ____ I have a relative who has a severe mental illness. ____ I have watched a documentary on television about severe mental illness. ____ I live with a person who has a severe mental illness. TV and Mental Health 82 Appendix E - Full Study Measures – TUBE I 1. When watching TV, which genre is your favourite (e.g., science fiction, drama, comedy, etc)? Section I. The following questions concern TV Drama series. This type of show is serial in nature (i.e., at least weekly episodes with a consistent set of main cast members). It excludes comedies, science fiction and continuous cast reality TV shows. The following are examples of TV drama series: House, Grey’s Anatomy, M*A*S*H*, Law & Order, CSI, and Prison Break. 2. In the spaces provided, rank order your three favourite TV drama series that you watch on a regular basis (you can include those listed above and any others that fall into this category). If you do NOT watch any shows of this type, please go to Section II (page 3). i. ii. iii. . Please use your favourite TV drama series (see Question 2.i) to answer the following questions Never 3. 4. 5. 6. 7. 8. 9. 10. 11. Frequently How often have you downloaded episodes or purchased or rented previous seasons of this show? 1 00000 2 1 0 How often do you visit or participate in websites or Blogs associated with this television show? 1 000 2 1 0 How often do you think about the storyline of the show in between episodes? 0 1 If you miss an episode, how often do you ask friends, co-workers or family what happened? 0 How often have you missed work or changed your schedule to make sure that you are home to watch this show? 2 3 3 4 3 4 4 2 3 4 2 3 4 1 2 3 4 0 1 2 3 4 How often do you talk about this television show with someone (e.g., a co-worker, friend, family member)? 0 1 2 3 4 How likely are you to make sure that you are available to watch this television show? 0 1 2 3 4 How often do you record or download the show when you are not available to watch it at its scheduled time? 0 1 2 3 4 How often are situations presented that deal with mental health related issues? 0 1 2 3 4 TV and Mental Health Not Realistic 12. Overall, how realistic is this TV series? 13. How realistic are the set locations? 14. How realistic are the outcomes? 15. How realistic are the characters? 16. How realistic are the attitudes of the characters? 17. How realistic are the characters’ personal interactions? 18. How realistic are the professional interactions with the characters? 83 Very Realistic 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Please answer the following questions regarding episodes in this series that include storylines that deal with mental health issues Not Realistic 19. Overall, how realistic are these storylines? 20. How realistic are the depictions of mental health disorders? 21. How realistic are the associated outcomes? 22. 23. 24. 25. Very Realistic 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 How realistic are the characters suffering from a mental health disorder? 0 1 2 3 4 How realistic are the attitudes of the characters depicted as having a mental health disorder? 0 1 2 3 4 How realistic are the interactions that occur between the character with a mental health disorder and friends/family? 0 1 2 3 4 0 1 2 3 4 How realistic are the interactions that occur between the character with a mental health disorder and professionals (health care, legal, etc.)? The following questions pertain to your favorite character in this TV Drama Series 26. Who is your favorite character in this TV series? Not Really 27. Overall, how closely do you identify with this character? 28. How closely do you identify with his/her personality? 29. To what extent do you identify with his/her occupation? Completely 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 TV and Mental Health 30. How closely do you identify with his/her current work situation? 31. 32. 0 1 2 3 4 How closely do you identify with his/her current personal situation? 0 1 2 3 4 To what extent do you want to work in the same occupation/ profession as this character? 0 1 2 3 4 Never 33. 84 How often do think about this character in between episodes? 0 Frequently 1 2 3 4 Section Il. We now want you to think about your favourite serial TV show that you currently watch on a regular basis. This show can be any type (e.g., comedy, science fiction, continuous cast reality TV) so long as it has a consistent set of cast members and you watch it regularly. The following are some examples of serial TV shows: Corner Gas, Stargate SG-1, Scrubs, Little Mosque on the Prairie, Sex & the City, Survivor, and The Amazing Race. If your favourite show is the one that was discussed in Section l or if you do NOT watch any shows of this type, please go to Section III (page 5). 34. In the space provided, list your favourite TV series that you currently watch on a regular basis (you can include one listed above or any other that fall into this category). Please use your favourite serial TV show to answer the following questions Never 35. 36. 37. 38. 39. 40. Frequently How often have you downloaded episodes or purchased or rented previous seasons of this show? 1 00000 2 1 0 How often do you visit or participate in websites or Blogs associated with this television show? 1 000 2 1 0 How often do you think about the storyline of the show in between episodes? 0 1 If you miss an episode, how often do you ask friends, co-workers or family what happened? 0 How often have you missed work or changed your schedule to make sure that you are home to watch this show? How often do you talk about this television show with someone (e.g., a co-worker, friend, family member)? 2 3 3 4 3 4 4 2 3 4 2 3 4 1 2 3 4 0 1 2 3 4 0 1 2 3 4 TV and Mental Health Never 41. 42. 43. 85 Frequently How likely are you to make sure that you are available to watch this television show? 0 1 2 3 4 How often do you record or download the show when you are not available to watch it at its scheduled time? 0 1 2 3 4 How often are situations presented that deal with mental health related issues? 0 1 2 3 4 Not Realistic 44. Overall, how realistic is this TV series? 45. How realistic are the set locations? 46. How realistic are the outcomes? 47. How realistic are the characters? 48. How realistic are the attitudes of the characters? 49. How realistic are the characters’ personal interactions? 50. How realistic are the professional interactions with the characters? Very Realistic 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Please answer the following questions regarding episodes from this TV series that include storylines that deal with mental health issues Not Realistic 51. Overall, how realistic are these storylines? 52. How realistic are the depictions of mental health disorders? 53. How realistic are the associated outcomes? 54. 55. 56. 57. Very Realistic 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 How realistic are the character(s) suffering from a mental health disorder? 0 1 2 3 4 How realistic are the attitudes of the character(s) depicted as having a mental health disorder? 0 1 2 3 4 How realistic are the interactions that occur between the character(s) with a mental health disorder and friends/family? 0 1 2 3 4 0 1 2 3 4 How realistic are the interactions that occur between the character(s) with a mental health disorder and professionals (health care, legal, etc.)? TV and Mental Health 86 The following questions pertain to your favorite character in this TV series 58. Who is your favorite character in this TV series? Not Really 59. Overall, how closely do you identify with this character? 60. How closely do you identify with his/her personality? 61. To what extent do you identify with his/her occupation? 62. How closely do you identify with his/her current work situation? 63. 64. Completely 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 How closely do you identify with his/her current personal situation? 0 1 2 3 4 To what extent do you want to work in the same occupation/ profession as this character? 0 1 2 3 4 Never 65. How often do think about this character in between episodes? 0 Frequently 1 2 3 Section Ill. Please answer the following questions as they pertain to your overall TV viewing habits: 66. Indicate, on average, how many total hours per week you watch of television: 67. Of this total, indicate how many hours per week fall into the following categories: a. Drama: hrs b. Talk shows: hrs c. hrs d. Daily news: hrs e. Reality: hrs f. Sports: hrs g. Documentary: hrs h. Science Fiction: hrs j. hrs Comedy: Other: Please specify: 4 TV and Mental Health 87 Appendix E - Full Study Measures – TUBE II PART 2 Please answer the following questions as they pertain to the episode of ER that you have just finished watching. Please note that there are no right or wrong answers to any of the questions about the TV episode. We are interested in your personal reactions, experiences and opinions -- whatever they may be. 1. Briefly describe the episode: Please answer the following questions regarding the entire episode that you have just watched. Not At All 2. 3. Very How interesting was this episode to you? How intensely were you concentrating while watching this episode? 4. How dramatic was this episode? 5. How emotional was this episode? 6. How realistic was this episode? 7. How realistic were the set locations? 8. How realistic were the outcomes of the storylines? 9. How realistic were the characters? 0 1 0 1 0 1 0 00000 2 000 2 1 2 3 1 3 4 3 4 4 2 3 4 2 3 4 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 TV and Mental Health 88 Not At All 10. How realistic were the attitudes of the characters? 11. How realistic were the characters’ personal interactions? 12. How realistic were the professional interactions between the characters? 13. How interesting were the characters within this episode? 14. Which character did you identify with most? Very 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Not At All 15. Overall, how closely did you identify with this character? 16. How closely did you identify with the personality of this character? 17. How closely did you identify with the occupation of this character? 18. How closely did you identify with the current work situation of this character? 19. 20. Completely 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 How closely did you identify with the current personal situation of this character? 0 1 2 3 4 To what extent would you like to work in the same occupation/ profession as this character? 1 2 3 4 0 The following questions concern the storyline(s) within the episode that contained mental health issues. You may leave questions 21-27 blank if you do not think that this applies to the episode that you watched. Please go to question 28 (top of next page). Not At All 21. How realistic were these storylines presented? 22. How realistic were the depictions of mental health disorders? 23. How realistic were the associated outcomes? 24. 25. 26. 27. Very 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 How realistic were the character(s) suffering from a mental health disorder? 0 1 2 3 4 How realistic were the attitudes of the character(s) suffering from a mental health disorder? 0 1 2 3 4 How realistic were the interactions that occurred between the character(s) with a mental health disorder and friends/family? 0 1 2 3 4 0 1 2 3 4 How realistic were the interactions that occurred between the character(s) with a mental health disorder and professionals (health care, legal, etc.)? TV and Mental Health 89 Not At All 28. 29. Very After watching this episode, how inclined are you to watch the next episode in this series? 0 1 2 3 4 After watching this episode, how inclined are you to watch this series on a regular basis? 0 1 2 3 4 30. Have you watched this series before? Yes 30a. If yes, how often? 30b. Have you ever seen this episode before? 31.  No Rarely 0 Yes   1 No 2 3 Frequently 4  Not sure  In the space below, please tell us any other thoughts, reactions that you had while watching the episode or afterwards. TV and Mental Health Appendix E - Demographics Questionnaire (full study) Please provide the following demographic Information. 1. Age 2. Sex years ❏ Male ❏ Female 3. Education ❏ First year undergraduate ❏ Second year undergraduate ❏ Third year undergraduate ❏ Fourth (or more) year undergraduate ❏ Graduate Studies Please specify highest level completed: 4. Marital Status ❏ Single ❏ Married or common-law ❏ Separated or divorced ❏ Other 5. Ethnicity ❏ ❏ ❏ Caucasian Aboriginal Asian 90 TV and Mental Health Appendix F: Order of Questionnaires Administered in Sessions I and II Session I Order 1 Order 2 Order 3 Order4 Order 5 Consent Form Demographics TUBE CAMI LOF NKQ MHI Consent Form Demographics CAMI LOF MHI TUBE NKQ Consent Form Demographics LOF MHI NKQ CAMI TUBE Consent Form Demographics NKQ TUBE CAMI MHI LOF Consent Form Demographics MHI NKQ TUBE LOF CAMI Session II Order A Order B Nunnally CAMI TUBE 2 CHS IMA CAMI Nunnally TUBE 2 CHS IMA 91 TV and Mental Health Appendix G - TUBE I - TV Series Viewing Habits Top 3 TV dramas watched Frequency CSI House Grey's Anatomy 18 16 12 Lost Prison Break Law and Order 8 7 5 24 Boston Legal Criminal Minds Desperate Housewives Dexter Law and Order: SVU Nip/Tuck 3 3 3 3 3 3 3 Bones Heroes One Tree Hill Ugly Betty Weeds 2 2 2 2 2 Big Love Breaking Bad Brothers and Sisters CSI: Miami CSI: NY Dead like me Entarage Gilmore Girls Medium Numbers OC Private practice Pushing Dasies River Cottage Treatment Sarah Connor Chronicles Sex and the City The Hills The Practice Two and a Half Men Total 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 116 92

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